$50,000 From IL Dept of Commerce To SALF To Provide 1st Aid Training To Chicago Police (2000-01)

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FOR IMMEDIATE RELEASE

November 13, 2000
Ryan: $1.1 Million in Illinois FIRST Projects for Suburban Cook County
SPRINGFIELD -- Governor George H. Ryan announced today that he is releasing $1,162,500 in Illinois
FIRST funding for projects in Suburban Cook County, including $500,000 to the Village of Maywood to
complete the second phase of renovations to the existing public pool.
The completion of the renovation will meet all American with Disabilities Act compliance criteria and
improve recreational opportunities.
This Illinois FIRST project was initiated by State Sen. Kimberly Lightford, D-Chicago
Other Illinois FIRST grants announced by Ryan:
• $200,000 to Harwood Heights to construct a new Municipal Complex.

This project was initiated by State Sen. Walter W. Dudycz, R-Chicago and State Rep. Michael P.
McAuliffe, R-Chicago.
• $100,000 to the Village of Morton Grove to reconstruct and enhance Dempster Street.
This project was initiated by Dudycz.
• $100,000 to Leaning Tower YMCA, Niles to construct a new senior center.

This project was initiated by State Rep. Ralph C. Capparelli, D-Chicago and Dudycz.
• $35,000 to Joseph Academy, Niles to renovate a warehouse into an educational facility.

This project was initiated by State Sen. Dan Cronin, R-Elmhurst.
• $25,000 to Intervention Instruction, Inc. to implement the DUI Prevention Initiative "What's Driving
You?"
This project was initiated by Capparelli.
• $50,000 to Ridgewood High School, Norridge to replace the existing fire alarm system.
This project was initiated by McAuliffe and Dudycz.
• $50,000 to Save A Life Foundation, Inc., Schiller Park to purchase equipment and materials.
This project was initiated by Dudycz and Capparelli.
• $25,000 to Stock School, Chicago to purchase computers.

This project was initiated by Dudycz and Capparelli.
• $25,000 to Edison School, Chicago to purchase computers.

This project was initiated by Dudycz and McAuliffe.
• $25,000 to Dirksen School, Chicago to purchase computer equipment.

This project was initiated Dudycz and McAuliffe.
• $12,500 to Beard School, Chicago to purchase computers.
1 of 2
Illinois DeDartment of Commerce and Community Affairs
George H. Ryan
Pam McDonougii
Governor
Director
TO: Ms. Carol Spizzirri, President

Save A Life Foundation, Inc.
FROM: Susan Boggs, Illinois First Grant Management Unit
DATE: June 29, 2000
RE: FY 2001 Grant Appropriation
Project No.: SD0183

Appropriation Section No.: HB4437 75 1260
Amount: $25,000
Purpose: various costs for "Blue Angels" life saving program
Legislative Sponsor: Senator Dudycz
Please be advised that the Department of Commerce and Community Affairs has been
given the responsibility of administering the above mentioned grant. In order for us to begin the
process, you are being asked to complete the enclosed survey form. The information supplied
on this form will allow us to develop a formal grant agreement (legal document).
Once the grant agreement process is completed and all documents are in order, we will
begin the payment process. Be aware that there is no set timeline for grant recipients to
receive their funds; however, processing time is largely determined by the accuracy of
the information contained in the survey.
Please note that the first page of the survey provides some important points to keep in
mind while filling out the survey. If you have questions, feel free to contact me at 217-782-5346.
Completed surveys may be mailed to: DCCA

Susan Boggs
620 East Adams, Mezzanine
Springfield, Illinois 62701
Or fax the survey to: 217/557-9883
Internet Address http://www.commerce.staie.il.us

620 Easi Adams Street James R Thompson Cenlcr 325 West Adams Street. 3rd Floor 2304 West Main
Springfield. Illinois 62701 100 Wesi Randolph Siren. Surte 3-400 Springfield. Illinois 62704-189: Manon. Illinois 62959
Chicago. Illinois 60601
:i7/7s:-7soo 3I2.'814-7IT9 217/7SJ-28OO 618/997-4394

Fix 217 765-6454 aTDD 80O785-6055 Fax 312 814-6732 «TDD 8O0 4I4.0667 Fax 217,785-2618 «TDD 217/785-0211 Fax 6I8.W7-1S25 . TDO Relay 800'526-08M
Primed on Recycled and Recyclable Paper

Member Initiative Grant Survey
.mi 1 Z TM
1) Grantee/Project Information
Illinois First Grant Unit
City: S <:*,->''*■ c <r~/c ,^ Sute:

(Mandatory)
County: C c~ C Business Phone:
Far f <-V 7 E-mail address: _
Name of Project Contact/Administrator of Grant {if other than chief executive office)'.
(Enter name of the projea contact person ifsomeone diner titan grantee's chief executive officer)
Title: Contact's Phone ( )_
Far( ) - E-mail address:
TYPE OF ORGANIZATION (CAedkonfy one):
D Individual D Governmental Entity

D Owner of Sole Proprietorship I I Nonresident alien
iZ3 Partnership D Estate or legal trust
D Tax-exempt hospital or extended care facility D Foreign corporation, partnership or trust
O Corporation providing or billing medical and/or health I—• Other - not-for-profit organization:
care services
Z) Corporation NOT providing or billing medical and/or
health care services D Other
SI Not-for-profit Corporation
Z! Medical & Health Care Provider Corporation (If not-for-
profit, please include a separate list of all board members)
For entities other than governmental entities, indicate the year that the organization was legally established: /
C" Attach documentation of Good Standing Status. {Availablefrom the IBmois Secretary of State's office.)
FEIN:' [-digitfederal employer identification number)
Owner of FEIN: ■ — - •" " <- ■-">:-• ~t--L ,-i
(NOTE: You must provide the FEIN number of the entity that will directly receive the grantfundsfrom DCCA. Do not use die FEIN
number of any subgmntee or affiliate of the grantee.)
page 2
2) Please use the space below to provide a detailed description of the Project, wfcaA will be funded by the grant {e.g..
construction/renovation activities; equipment/land acquisition; deveuypmentlde&my of programs and services [including
administrative activities}; or other «tfWrie).This information will be included in the grant agreement as the Scope ofWork.
SCOPE OF WORK
The purpose of the Blue Angels program will provide "train the trainer" instruction to
enough police personnel in order to outreach fellow Chicago police officers with on
going basic hands-on Life Supporting First Aid (LSFA), including cardiopulmonary
resuscitation (CPR), training and the development of action plans for emergency/disaster
preparedness. All SALF police instructors will also assist in outreaching local
elementary and high school students with either a one or two hour basic life savine skills
program. 5»*«»
SALF's Blue Angels will establish a working relationship with the Boards of Education
in the Chicago school districts, their teachers, parents, police and school bus drivers
agents with the purpose of demonstrating life saving skills to the students in Chicago
schools. The campaign will recruit 300 Police instructors to outreach to 2500 of their
own police officers for emergency medical/first responder skills as SALF instructors
Among the skills to be taught are "Bystander Basics," a life supporting first aid program,
and CPR training.
SALF Instructors will deliver "on sight" basic LSFA training to the police volunteers
Those police officers volunteering for the Blue Angels program will need some prior
medical background. This background can be in EMS services, paramedic work, CPR
training, or prior nursing experience.
The funds will be used for the cost of supplies, including mannequin sets training
manuals, emergency bystander kits, and completion cards. Additional costs will include
the cost of training 30 instructors and administrative costs
page 2
inoisKRSF
If this grant will be funding a social service program (ie., after schoolprograms through a Boys & Gbis Club,job training, Ac), please continue
with questions 3 & 4. If you are not a social service provider, please skip to question 5.
3) Describe any eligibility criteria for participation in your program (it, income level age, employment status, etc.):
4) Provide a detailed description of: a) your program's goals; and b) services provided to eligible clients. If there are different
levels of eligibility {such as ranges of client income), please describe the services provided to each level if they are not identical.
b) /; /
If your program is viewed to be consistent with the goals of the federal Personal Responsibility and Work Opportunity Reconciliation
Act of 1996 (PRWORA), further information may be requested.
5) Why is this project necessary? What is the expected benefit of this project (e.j, city will no longer be on IEPA nstriaed status
lisr, unemployed persons will reeev/ejob training, etc)7. /■/, <r- /*, jc ^v-c r IS ■-, ■,- .- -'ev^c s^c ''
.-"77V <■ • •-.• <-• ■ , >. .- .'.--.-".- ■_--/-' > . ,. ^ ■. -y.-c t.^'C v
6) Estimated Number of Persons to be Served/Benefited from Project _uf____
1 page 4
SinoisFlRSF
7) Attach copies of any public hearings, board meeting minutes, newspaper articles, or other documents that would
evidence local support for this project (ifavailable). fe'/t-sj./^ /»?<?■& 7-^^^ Af^^'^-^'^S
8) Do you anticipate any opposition to this project? CD Yes SI No If yes, please describe:
9) Timetable for Completion: Start Date C^ I G/ / QQ Completion Date: <^6 \ J C \QX

(NOTE: Project should not begin prior to July 1,2000 and must be completed no later than June 30,2001)
a) Describe any actions/approvals that must be completed prior to the start of this project, with corresponding time
frames for completion:
b) Provide an estimated monthly expenditure of grant funds once the project starts:
Month 1: $ 3 7«PQ Month 13: S
Month 2: ■--'■ ~/C C Month 14:
Month 3: .-2- > ~^ Month 15:
Month 4: •" - Month 16:
Months: -• !/ '; c Month 17:
Month 6: -' '" '<-' Month 18:
Month 7: • '- c' Month 19:
Month 8: " '"-'•' Month 20:
Month 9: '- ■' ■ *- Month 21:

. Month 10: ■+ ' '■' - Month22:
Month 11: Month 23:
Month 12: Month 24:
(NOTE: include onfygrantfunds m das estimated monthly cash flow, not any matchingfimdsfrom other sources.)
itaoisBRST-
10) When completed, this information will be incorporated into the grant agreement as the Project Budget Activities listed
in this budget should be consistent with activities described in the Scope of Work. (See sample budgets on not two pages.)
' BUDGET
ACTIVITY LINE ITEM GRANT AMOUNT OTHER PROJECT FUNDS

(if applicable)
C-> . -*■ C-
TOTALS yj ^,£.
* For all personnel being paid in-full or in-part with Illinois First Grant Funds, a complete job description must be included.
» This column cannot exceed the grant amount to be received from DCCA.
Save A life Foundation
Additional information for the Blue Angels Program
> Training Equipment: Mannequin sets - 43 mannequin sets at $100 each Includes
lungs and face shields
> Training Materials:
30 Manuals -$1,500
412 Student Books - $824
400 Completion Cards - $40
400 Certificates - $400
30 Completion cards for Instructors - $30
30 Certificates for Instructors - $30
30 Instructor ID's - 30 @ $5 each
30 Instructor shirts - $600 @ $20 each
430 pins - $860
$3900 Salaried positions:

> Director: $335
> Accounting Clerk: $575
> Project and Research Director: $1,050
> Service Coordinator: $750
> Scheduler: $540
> MIS: $650
> Instructors: There will be two types of instructors. First there are the SALF
instructors who will train the 30 senior police instructors. These senior police
instructors are the second type, and it is these individuals who will outreach their
fellow police officers with the CPR and emergency first aid skills
> Instructor fees are the fees paid to both the "train the trainer" and the senior police
officers who conduct these classes.
> Overhead: The original amount submitted of $913 is the correct figure. This cost
is for rent and insurance.
> Benefits: cost goes for unemployment insurance.
SAVE A LIFE FOUNDATION
Training Equipment for Trainers:

2 mannequin sets
1 instructor shirt
I Identification badge
1 training manual
2 bystander kits
Supplies issued to each new student:

1 program book
1 course completion card
1 bystander kit
Number of people: 30 police instructors to serve as SALF trainers.
Tnrtmrtf)r fay;- ??* ,
Overhead: $3,985 (approx)

11) Other Funding: Are other funds necessary to complete this project? E Yes D No
If yes, indicate the amount, source and status of those funds below:
• Amount of Federal Matching Funds: $ Status: D Approved D Pending

{Name of Federal Funding Agency: _ )
• Amount of Local Matching Funds: $ Status: D Approved □ Pending

(Source of Local Match: ___ )
• Amount of other State Funds: S -5rag"' <r^scr t <rs<r& Status: 12 Approved D Pending
{Name of Other State Funding Agency: 5<g-g==~ <& ^s<Z <£&£&-4? ; J
• List other Illinois FIRST grants this grantee is receiving this Fiscal Year (FY'01):
• List any other grants this grantee received from DCCA within the last three years (Provide DCCA Grant Number):
This survey was completed by.
Printed Name
■77. ~? 1 <f 1 &&

Signature ' Date
page 9
Save A Life Foundation
> Training Equipment: Mannequin sets -43 mannequin sets at $100 each Includes
30 Manuals- $1,500
412 Student Books -$824
400 Certificates-S4©0-© .JQS^ y
430 pins - $860

> Director: $335
> Project and Research Director $1,050
> Scheduler $540
> MIS: $650
instructors are the second type, and it is these individuals who will outreach then-
fellow police officers with the CPR and emergency first aid skills.
Date: Wednesday, August 09,2000
To: DCCA Department of Commerce and

Community Affairs
Susan Boggs
Phone: 217-782-5346
Fax: 217-557-9883
From: Save A Life Foundation

Carol J. Spizzirri
Phone: 847-928-9683
Fax: 847-928-9684
Pages: 2
Subject: $120 error on both applications
Correction of $120 reflected on Certificates as follows.

Car phone #847-612-5730.
I'll be in Springfield all day if you need me, I'll be right

over. Sitting up at the State Fair in the Fire Marshal's
Tent or at our oiiice at St. John's Hosp. Thanks, Carol
File Number 5717-789-6
To all to whom these Presents Shall Come, Greeting:
I, Jesse White, Secretary of State of the State of Illinois, do

hereby certify that SAVE A LIFE foundation, inc., a domestic
CORPORATION, INCORPORATED UNDER THE LAWS OP THIS STATE FEBRUARY 9,
1993, APPEARS TO HAVE COMPLIED WITH ALL THE PROVISIONS OP THE
GENERAL NOT FOR PROFIT CORPORATION ACT OF THIS STATE, AND AS OF
THIS DATE, IS A DOMESTIC CORPORATION IN GOOD STANDING IN THE STATE
OF
In Testimony Whereof, i, hereto set

my hand and cause to be affixed the Great Seal of
the State of Illinois, this 2oth
day of J*LY AD. _ 2000
SECRETARY OF STATE
C-260.1
GENERAL ASSEMBLY
STATE OF ILLINOIS
June 7, 2000
Ms. Carol J. Spizzirri - President

4825 N. Scott St., Suite 74-A
Schiller Park, IL 60176
Dear Ms. Spizzirri:
You have been selected to receive a $50,000.00 grant for the "Blue Angels" Life Saving Program
through a legislative initiative sponsored by our offices from the 2000-2001 Elinois State budget.
There are several things that need to be emphasized regarding this legislative initiative. First,
since the money for your grant is coming from the Fiscal Year 2001 Illinois State budget, the
funding will not be available until after July 1,2000. Second, although July 1,2000 is the first
day that the funding for legislative initiative is available, it will be several months before you will
actually receive the money for your grant. This is due to the process that each grantee must go
through before an actual check can be cut and usually takes several months to complete. This
process has been established by the Governor's office and includes the following steps:
After the project is released by our offices, a letter goes out to the agency handling the grant,
which we believe in your case is the Department of Commerce and Community Affairs (DCCA),
the Governor's Office and the Bureau of the Budget, indicating our desire to move forward on the
legislative initiative.
DCCA should then send you a project survey form that asks for a detailed description of your
project for their evaluation. After the project survey form is returned to DCCA and the program
staff who is handling your grant finds no problems with it, the agency should forward the request
for release of funds to the Governor's Office. If there are problems with the project survey form,
the program staff at DCCA should be in touch with you to resolve those problems so that the
request can be forwarded to the Governor's office as soon as possible.
Once the Governor's office reviews the project and issues a release, DCCA should send you a
grant agreement package which needs to be looked over and read carefully, signed and returned
to DCCA as quickly as possible. After the signed grant agreement is received at DCCA, a
voucher should be issued and sent to the Comptroller's office for processing. The Comptroller's
office should then send you a check in a matter of days for the amount of your grant.
Recycled pnpor • soybean ink

If your project is being issued from bond funds, such as the Capital Development Fund, there are
some additional steps in the process. First, bond fund releases need to be approved by the Bureau
of the Budget This step occurs before the Comptroller can issue a check. Second, you will only
receive half of your grant amount up front, if the grant is from bond funds. The other half of your
grant will be issued on a reimbursement basis, with the agency's receipt of your "quarterly
report". This report should be included in your grant agreement package with instructions on
how to proceed. In addition, the program staff member from DCCA should be helping you along
during every step in the process and should inform you of how your grant will proceed at each
juncture.
This process can be frustrating, so your patience is required. If you are having problems or need
assistance, please call any one of our offices and we'll see what we can do to help.
Sincerely,
Walter W. Dudycz J Ralph Capparelli'

State Senator, 7th District State Representative, 13th District
F rrBCA-5.10
NFP-105.10
(Rev. Jan. 1999)
Jesse White
Secretary of State
Department of Business Services
Springfield, IL 62756
Telephone (217) 782-3647 SUBMIT IN DUPLICAT"
http://www.sos.state.il.us
This space for use by
Secretary of State
Date
STATEMENT OF
CHANGE
OF REGISTERED AGENT
Approved:
AND/OR REGISTERED
OFFICE Remit payment in check or money order,
payable to 'Secretary of State."
Type or print in black ink only.

See reverse side for signature(s).
1. CORPORATE NAME: Save A Life Fcmndation .
2. STATE OR COUNTRY OF INCORPORATION: Illinois
and re9istered offlce as they appear on lhe ■««*

Registered Agent Caro1 JeanSpizzirri
First Name Middle Name Last Name
15 Commerece Drive
Registered Office ■
: ZIP Code " co~un~ty

4.
Name and address of the registered agent and registered office shall be (after all changes herein reported):
Ritd Agent
Registered A >_Caro1-
Caro1J Jean Spizzifri
Registered Office 4825 N. Scott, St. , Suite 74-a
Street Suite No. (A P.O. Box alone is not acceptable)
Schiller Pane, II 6017.'* Cook
City ZIP Code County
FOR 1999 GENERAL NOT FOR PROFIT CORPORATION ACT NLC NU. N 3urio7-u
SECRETARY OF STATE OF ILLINOIS

FILE PRIOR TO 02-01-99 DO NOT WRITE IN THIS SPACE
.. ADD S3.00 PENALTY
FOR LATE FILING ANNUAL REPORT
FILING FEE $5.00
1.) SAVE A LIFE FOUNDATION, INC.

% CAROL JEAN SPIZZIRRI 020993 06 J
17479 W DARTMOOR
GRAYSLAKE, IL. 60030
LAKE
2.) NOTE: DO NOT ALTER ITEM 1.
Form NFP 105.10 must be filed in this office in order to change THE REGISTERED AGENT and/or REGISTERED OFFIC
3.) The above corporation organized under the laws of the state of ILLINOIS . pursuant tc
provisions of "The General Not for Profit Corporation Act" of the State of Illinois, hereby makes the following report:
4.) THE NAMES AND RESPECTIVE RESIDENTIAL ADDRESSESS OF ITS OFFICERS AND DIRECTORS ARE:
NAME OFFICE NUMBER & STREET CITY STATE ZIP

President
Carol J. Soizzirri
-€arol J. Spizzirri
-Carol Ji-SpiZzir-g4
Director
-Rick Bronstoin
Director
NOTE: List all directors above or list them on an additional sheet: Illinois corporations must haveTHREE directors.
5.) The following is a brief statement of the character of the affairs which the corporation is actually conducting:
Training/education in Life Supporting First Aid and emerg. preparedness
6.) Is this corporation a CONDOMINIUM Association as established under the Condominium Property Act?
Yes [j No [x] (CHECK ONE)
Is this corporator a COOPERATIVE HOUSING CORPORATION defined in Section 216 of the Internal Revenue Code of 1954?
Yes No (CHECK ONE)
IS this a HOMEOWNER'S ASSOCIATION which administers A COMMON-INTEREST COMMUNITY AS DEFINED IN SUBSECTION (C)
of Section 9-102 of the Code of Civil Procedure?
Yes Q No \x\ (CHECK ONE)
7.) If a foreign corporation, the address of its principal office in the state of its incorporation is:
(Number and Street) (State or Country}
CVfiV
<4Please read reverse-side of this report before signing below)
8.) BY A tji Under me penalty ot perpiry iiki as an auino'KM oiltctt I ok
(Xuthonzea Olfickrs Signamre) (Title) mis annual repod. pursuant lo provision! ot m« General Notf
Corporation Act. nas Been tunmeo oy me ana is. 10 ing ee
knowinage ana Muet. inj*. correct, and comotoie
ITEM 8 MUST BE SIGNED

5. The address of the registered office and the address of the business office of the registered agent as chanced
. will be identical. ■ a '
6. The above change was authorized by: ("X* one box only)
a. □ By resolution duly adopted by the board of directors. (Note 5)
b. S| By action of the registered agent. (Note 6)
NOTE: When the registered agent changes, the signatures of both president and secretary are required.
7. (If authorized by the board of directors, sign here. See Note 5)
_ The undersigned corporation has caused this statement to be signed by its duly authorized officers each of
whom affirms, under penalties of perjury, that the facts stated herein are true. °nicers, eacn oi
Dated *&1M&ITl] ?fr , /9?6f Save A Life Foundation, inc.

(^ctNameofCorporation)
attested by
istant Secretary) (Signa^reofpt&dent or Vice President)
Sec. sbifrzirri/President
rol 3 sbifrzii resi
(Type or Print Name and Title) (Type or Print Name and Title)
(If change of registered office by registered agent, sign here. See Note 6)
The undersigned, under penalties of perjury, affirms that the facts stated herein are true.
Dated January 30 1999 [
(Month & Day) (Year) lSig)patun\ o\fygistered Agent of Record)
NOTES
1. The registered office may, but need not be the same as the principal office of the corporation. However the
registered office and the office address of the registered agent must be the same. nowever, me
2. The registered office must include a street or road address; a post office box number alone is not acceptable.
3. A corporation cannot act as its own registered agent.
4. If the registered office is changed from one county to another, then the corporation must file with the recorder
of deeds of the new county a certified copy of the articles of incorporation and a certified copy of the statement
of change of registered office. Such certified copies may be obtained ONLY from the Secretary of State
5. Any change oi registered agent must be by resolution adopted by the board of directors. This statement must
then be signed by the president (or vice-president) and by the secretary (or an assistant secret
6. The registered agent may report a change of the registered office of the corporation for which he or she is
registered agent. When the agent reports such a change, this statement must be signed by the registered
C-135.13
ARTICLES 0F INCORPORATION OF
SAVE A LIFE FOUNDATION, INC.
Ir?^?^!^ UNDER THE LAWS 0F THE STATE °f ILLINOIS HAVE BEEN
FILED IN THE OFFICE OF THE SECRETARY OF STATE AS PROVIDED BY THE
GENERAL NOT FOR PROFIT CORPORATION ACT OF ILLINOIS, IN FORCE
JANUARY 1, A.D. 1987.
lin (Ui
9TH
FEBRUARY
£ne> tcao, Auncbed and 17TH
C212
NFP-102.10 ARTICLES OF INCORPORATION (Do Not Write in This Space)
(Revised5-88)
SUBMIT IN DUPLICATE Date ^?-

Payment must be made by Certified Check. Cashier's
Check. Illinois Attorney's Check, Illinois C.P.A.'s Check Fllin9 Fee S50
or Money Order, payable to 'Secretary of State *

DO NOT SEND CASH! Approved
TO: GEORGE H. RYAN. Secretary of State
Pursuant to the provisions of "The General Not For Profit Corporation Act of 1986". the undersigned incorporator(s)
hereby adopt the following Articles of Incorporation.
Article 1. The name of the corporation is: SAVE A LIFE. FOUNDATION. INC.
Article 2: The name and address of the initial registered agent and registered office are:
Registered Agent rai-r.1 ■Tean Spizzirri

First Name Middle Name last Name
Registered Office 17A7Q t.t
Number Slreet
(Do Not Use P.O. Box)
60030 Lake
Ci«y Zip Code County
Article 3: The first Board of Directors shall be 2
in number, their names and residential addresses
being as follows: (Not less than tnree>
Address
Director's Names Number Street Cltv
Carol J. Spizzirri
Sandra L. Engberg
Lee E. Jungkans
Article 4. The purposes for which the corporation is organized are:
To promote basic emergency first aid and CPR for all public servants.
Is this corporation^ Condominium Association as established under the Condominium Property Act?
□ Yes E] No (Check one)
Is this corporation a Cooperative Housing Corporation as defined in Section 216 of the Internal Revenue Code
of 1954? LJYes E] No (Check one)
Is this a Homeowner's Assoc.ation which administers a common-interest community as defined in subsection

(c) of Section 9-102 of the code of Civil Procedure? □ Yes [7] No
Article 5. Other provisions (please use separate page):

each antf every Director; Trustee and Officer proposed for this insurance to facilitate the proper and accurate completion
of this Proposal Form. The undersigned further agrees that if any significant adverse change trt'the condition of the
applicant is discovered between the date of this Proposal Form and the affective date of the Policy, which would render
this Proposal Form inaccurate or incomplete, notice of such change will be reported in writing to the Insurer immediately.
The signing of this Proposal Form does not bind the undersigned to purchase the insurance, but it is agreed that this
Proposal Form and any material submitted therewith are their representations and that they are material. It is further
agreed that this Proposal Form and any material submitted therewith shall be the basis of tha contract should a Policy be
issued, and this Proposal Form and any attachments thereto wilt be attached to and become a part of the Policy.
By \_ fAfiV^ >>Pa1^N'\A , Date

Title _J
•A POLICY CANNOT BE ISSUED UNLESS THE PROPOSAL FORM IS PROPERLY SIGNED AND DATED.*
A copy of each of the following documents will be provided at the time the completed Proposal Form Is submitted.
a. COMPLETE COPIES OF THE ORGANIZATION'S LATEST TWO ANNUAL REPORTS OR ANNUAL

AUDITS/EXAMINATIONS.
b. COPY OF THE ORGANIZATION'S ARTICLES OF INCORPORATION/CHARTER.
C COPY OF THE ORGANIZATION'S BY-LAWS.
U is represented that the p.rticulars and statements contained in the Proposal Form are true and are the basis of this
Policy and are to be considr red as incorporated in and constituting part of this Policy.. However, this Policy shall not be
voided or rescinded and cov srage shall not ba excluded as a result of any untrue statement in the Proposal Form, except as
to those persons making such statement or having knowledge of its untruth.
Submitted by Karen S. Crane Date

(MOOUCSA)
JMB Insurance Agency, Inc. , 900 North Michigan Avenue. Suite 1700. Chicago. TT. fin.611
NOTE: This Proposal including any material submitted therewith shall be treated in strictest confidence.
AMERICAN SPECIAL RISK, IRC.

500 WEST MONHOE: SUITE 20Z0
rrnrmyi n, 60661
Phone: 32.2-474-0400
Fax: 312-474-0404
Board of Directors Meeting
JuneI5. 2000
Held at the offices of:
LaveUe. Motla, Klopfemtein & Saletta, LTD.
9240 West Belmont Franklin Park, Illinois 60131
J'rcMMit Members:
Ahseul Members: Stijn /ullo. Ml)

M;irtin Si"ld"v"
(•lies I:
I'rcscn I: I Job Motla osq.
Discussion Action
Call Meeting lo Order Carol Spizzirri called board meeting lo order.
(On tape 1 side I from 000 003)
Minutes of'April 20, 2000 Carol Spizzirri for Dcloris Burnhain who was absent
Carol motioned for the minuies lo be
(On tape I side 1 from 004-0 M)
accepted as present . Hon. Sam Amiranlc,
seconded, motion passed,
Financial Report Carol Spizzirri for Scott Anderson
We will not he getting our fiscal year
(On tape I side 1 from 012 450)
money until mid September for 2001.
Carol motioned that SALI would have lo
generate a loan for $ 100.000. Sam
■ Continuing discussion about the loan
Amiraiite second the motion. It was carried
Carol made a motion to accept Martin

Sandoval as a member of Board oi*
I )ircct«rs. Mart in spent 16 years with the
federal (iovernmeni. Currently
Commissioner on County Board of Water
Reclamation, First Latino on the Water
Board, First Democrat appointed by
> Nominations of: Martin A.
Republican to the board. Nine years
Sandoval, Margie Lawless, Carol Spizzirri presents the nominal ions of:
> Martin A. Sandoval studying at a seminary for the priesthood.
Robert Motta to Hie Board of
(On tape I side I from 451-547) I -ost his sister 2 years ago. I .avelle second
Directors
the motion, motion was carried. Martin was
accepted lo the Board of Directors.
-Carol made a motion lo accept Margie

Lawless as member of Board of Directors.
H:\UOI) Minutes 8-00.doc
Margie Lawless is a Vice President of Harris
Bank. Motion moved by Carol Sptzzirri,
motion second it by Sam Amirante.
Carol Spi/zirri also nominates Margie Lawless
{On tape I side 1 from 548 615)
>Carol motion for Bob Motta to be on the
Board of Directors. Sam Amirante denied
the motion. Motion was denied.
Hob Motta
Bob Conroy motioned to allocate SALF

stair members to work on the Branch
Old Business Development Committee in the main office.
SAI,F Branches Jodie and I lank, as the office contacts, have
lo report back to the Committee. Motion
> New Branch request Bob Conroy
proposals seconded by Carlos Cortes, motion carried.
(On tape I side 2 from 000 648)
Discussion continues aboul the branches
Carol Spizzirri made motion to have Martin

Sandoval, Michael Lave lie. Sam Amtranle,
and Carlos Cortes to serve on a Public
Relations Committee to find a company that
would fulfill our purposes to their best
interest. Michael l.avelle was appointed to
chair this Committee, he accepted the
'*•■••■ ■<! <\:is cuiricd
> Blue Angels Carlos Cortes made motion to be the

Director of the Blue Angel Committee. He
Carlos Cortes and Wayne Wiberg
will put an ad in the FOP newsletter to gel
(On tape I side 2 from 649-700)
Police officers to become Instructors. The
newsletter reaches 16 thousands Police
Officers. The Police officers will require
some medical background. Carlos and
Wayne will create a logo with the Save A
Life shield and Angel wings on it. Thai is
going to called Blue Angel's Squad".
E I:\BOD Minutes 8-00.doc

Carol added that boih Senator Walter
The discussion continues
Dudycz and Rep. Ralph Capparelli have
{On tape 2 side I from 000-024) allocated 50 thousands dollars towards the
Blue Angels out of their funds. We should
be receiving that money in September,
which will only serve the purpose of the
Blue Angels. The Senator offered to chair
the Blue Angels. Motion was seconded by
Mike Lavelle, and carried.
Hob Molia reports

Mattel Law Suit
(On tape2 side 1 from 025-188)
A complaint was filed against Mattel on

June 8n 2000, At this point were in the
holding matter to see how Mattel is going to
respond. There was a press release thai was
drafted. Scoll Peterson and Bob Mima
reviewing it.
New Business
Board Responsibility questionnaire (Next Board

Board Productivity meeting)
and Redevelopment (On tape 2 side I from 199-540)
New policy/Committee procedures
(Tabled to next Board meeting)
Carol motioned to have Hoard Development
Committee Nominations
Committee. Motion was seconded by Sam
(Tabled to next Board meeting) Amiranle.
> Position for September [• led ion

(Next Bo«ird meeting)
Closing of the Meeting Spizzirri made a motion to close the m

Motion was seconded by Scott Anderson and
Until Augusi 17, 2000 at 6:30 pm (a) Molta's office carried.
H:\11OI) Minutes 8-00.doc

Honorary Chairman
David Hasselhofif, BAYWATCH Productions Medical Director
Stanley Zydlo, M.D
Illinois States Spokesnersnn
Hon. Jesse White, 1L. Secretary ofState Associate Medical Tiirrrtn,
Scott Betzelos, M.D.
Illinois State Ambassador
Mrs. Lura Lynn Ryan, First Udy of Illinois Medical Advisors
Peter Safar, M.D. Professor SRC. Unv. Pitts
Board of Director Henry Heimlich, M.D. OH
Carol Spizzirri, President/Founder SALF Ernest A. Pretto, Jr. M.D. VA Hosp. SRC Pitt
Hon. Sam Amirante Robert Boyd Tober, M.D. FACEPDir.EMS. FL
Scott Anderson Max Koeningsber, M.D. Chicago EMS Dir.
Scott Betzelos. M.D. Mikel Rothenberg. M.D. EMS Educator. OH
Deloris M. Burnam Nicholas Bircher, M.D. SRC. Unv. Pitts
Carlos Cortez CPO Uwe Ebmeyer, M.D. Germany
Bill Kugelmen
Stanley Zydlo, M.D. Blue Aneels Committee
Robert Conroy Sgt. Ron Gaines
Michael Lavelle Hon. Walter Dudycz
Commissioner Martin Sandoval
Margarette Lawless
Wayne Wiberg CPO
Leeat Council
Robert Motta, ESQ.
Advisory Council
US Sen. Richard Durbin, IL
ST. Sen. Walter Dudycz
ST. Sen. Steve Rauschenberger
St. Rep. Mike McAuliffe
St. Rep Ralph Capparelli
SALF Blue Angels Program Job
tJ I Pr,°Vide thC "trai"the trainers" instru«ion to Police instructors with

certified training m basic hands-on Life Supporting First Aid (LFSA) and
cardiopulmonary resuscitation training, using demonstration mannequins and first aid
kits. Trainers will conduct post-training tests and issue completion certificates.
Blue Angels Trainers: Train fellow police offices with certified training in basic hands-
on Life Supporting First Aid (LFSA) and cardiopulmonary resuscitation training using
demonstration mannequins and first aid kits. Trainers will conduct post-training tests Ind
issue completion certificates. SALF's Blue Angels will also work with the Chicago
Board of Education to provide LFSA and CPR training to school children
ILLINOIS DEPARTMENT OF COMMERCE AND COMMUNITY AFFAIRS
GEORGE H. RYAN "

GOVERNOR PAM MCDONOUGH
DIRECTOR
November 21, 2000
Ms. Carol Spizzirri

Pres/Founder
4825 N. Scott St.
Ste 74-a
Schiller Park, IL 60176-1214
Re: Grant No. 01-124154
Dear Ms. Spizzirri:
your 9rant
Sincerely,
Pam McDonough
Director
Enclosure
cc: DCCA Grant Manager
IM Imi «ami
SM WMt A«ntt Sirwi. Ir.
Iwti III
raoaooim-ww
Nov-14-2000 16:13 Frc-OCCA IL FIRST 217-557-8883 T-917 P 037/065 F-732
STATE OF ILLINOIS
DEPARTMENT OF COMMERCE AND COMMUNITY AFFAIRS
Notice of Grant Award No. 01-124154

LEGISLATIVE ADD ONS
This Grant Agreement (hereinafter referred to as the "Agreement")

is entered into between the Illinois Department of Commence and
Community Affairs (hereinafcer referred to as the "Department") and
(hereinafter referred to as the "Grantee)". Subject to t.erms and

conditions of this Agreement, the Department agrees to provide a
Grant in an amount not to exceed S25,000.00 to the Grantee.
Subject to the execution of this Agreement by both parties,

the Grantee is hereby authorized to incur costs against this
Agreement from the beginning date of 07/01/2000 through the ending
date of 06/30/2002. The Grantee hereby agrees to use thu funds
provided under the Agreement for the purposes set forth herein and
agrees to comply with all terms of this Agreement.
This Agreement includes the following sections, all of which are

incorporated into and made part of nhis Agreement:
Part:
I. Budget
II. Special Grant Conditions
III. Scope of Work
IV. Program Terms and Conditions
V. General Provisions
VI. Required Certifications
Under penalties of perjury, the undersigned certifies that the name

taxpayer information number and legal status listed below are correct.
If you are an individual, enter your name and SSN as it appears on vour
Social Security Card. If completing this certification cor a sole
proprietorship, enter the owner's name followed by the name of the
business and the owner's SSN. For all other entities, enter the name
of the entity (as used to apply for the entity's EIN) and the EIN.
Name: Save A Life Foundation
Taxpayer Identification Number:

SSN/EIN:
11/14/2000 11:52:15 - 1 -
Nov-14-2000 16:13 From-OCCA IL FIRST
217-557-9883 T-817 p 038/065 F-732
Legal Status (check one):
Individual Government entity

Owner of sole proprietorship Nonresident cilien individual
Partnership Estate or lecfal trust
Tax-exempt hospital or Foreign corporation
extended care facility . partnership estate or trust
Corporation providing or jk Other - not-for-profit
billing medical and/or organization:
health care services
Corporation NOT providing or Other:
billing medical and/or
The Grantee acknowledges that the individual signing below is authorized

to execute this Agreement and that such signature constitutes *^norizecl
acceptance of this Agreement.
GRANTEE:
3y:
STATE OF ILLINOIS DEPARTMENT OF COMMERCE AND COMMUNITY AFFAIRS

By: ytyy*- ' ' 'c *L) &T\.c
Pam McDonough" Dii^prtor Date"
Grantee Address:
Please indicate any changes below
4825 N. Scott St.
Ste 74-a
n
Chief Exec: Carol Spiz2irri

Phone: (847) 928 - 9683
The following is designated as administrator for the Grantee:
Chief Exec: p /
Phone: 7 *S
11/14/2000 11:52:15 - 2 -
PARTI
BUDGET
Activity Line Item Grant No. GranTNo.
NOTE:
IN THE EVENT THIS BUDGET REFLECTS EXPENDITURES FOR THE PROJECT

?SE?.!5FD 'N PART '" WHICH ™E GRANTEE HAS ADVISED THE DEPARTMENT ARE
ANTICIPATED TO BE PROVIDED THROUGH ADDITIONAL GRANT AWARDS GRANTEE
ACKNOWLEDGES (i) THAT THE AMOUNT OF FUNDS TO BE DISBURSED UNDER THIS
GRANT WILL NOT EXCEED THE AMOUNT STATED IN THE NOTICE OF GRANT AWARD
FOR IdlS^RANI; AND (ii) THAT THE DEPARTMENT'S OBLIGATION TO DISBURSE
SUCH OTHER FUNDS IS CONTINGENT UPON FINAUZATION OF A GRANT AWARD AND
EXECUTION OF A GRANT AGREEMENT FOR THE ADDITIONAL FUNDS
PART Il-Bl
SPECIAL GRANT CONDITIONS

(NONGOVERNMENTAL ENTITIES)
(Non-construction)
2.1
activities described in the scope *
funds within the grant period

); if not'
°b-ain Pri°r Written aPPr°vals from the Department for any

variances in its expenditure of grant funds
' Sncte 8 Gr3ntee 3deqUately aqcount for recejPts and expenditures of grant
# accordance
LaPPHliCable<with
-^dJhe Grantee return ânt funds to the Department in
the provisions of the Grant Agreement
package traceable to its
G?an?A^ment ^ ? ^n audit Conducted as a condition °< this

G an AegrA™t' r^' ' *? Grantee r6Ceives durinS the te™ <* this
oMM nok fn? th ( "" Previously received), additional grants from the State
?JZh\ h Pr°J!Ct described in Part III hereof, the Grantee shall be
hereof "" conducted as provided in Part V, Section 5.4C(a(iv!
22 PROJECTS REQUIRING nrjTPim. siGN.nrrQ
AGENCY SIGN-OFF SIGN-OFF

_ Illinois Historic Preservation Agency "COVB> 0UTSTAN0'NG
Dept. of Ailt
Illinois Dept Agriculture
Illinois Dept. of Natural Resources
X NO APPLICABLE
NONE
provisions of
2-3 PAYMENT PROVISIONS; PRIQR INCUBRFn rncTC

auê U,e State^mptroMer^ ^ce to dûrs/p^nt
ss
accordance with the provisions hereof,
ra
shall submit status/expense reports as
?^!!L!!T?: TheoGrantee sha" submit a Quarterly Status Report

lnSeRepOrt in the format Provided by the Department
sêTGranfeddar "* ^ 3 Calendar baSiS> thro^ the
V
-L. Final Reports: Grantee shall submit a Final Status Report and a Final
Expense Report in the format provided by the Department The F na
Reports are due no later than 30 days following the stated Grant end date
" hereof is due 45
nOt limited «• -trials sufficient to

Certifi" with the
(a) Grantee shall not use funding provided under this Agreement for sectarian purposes.
funds to any principai °r
an GrraanntefundsllorOt' W'th°Ut th* 6XPreSS Wrftten C°nSent of the DePartment,

Nov-14-2000 16,16 Frca-DCCA IL FIRST 2I7.557.8883
2.8 MUtTIPI-E GRANT AWARDS. If the Grantee was previously awarded a erant hw
$LJFm* -H-^^ aCtiVitleS and »?W/5fi

deveioped to fi ^
^l9,, IMPING ACKNQWLEPQMENL If requested by the Department the Grants
shall post signs at the project site or affix signs/decals to equTpme™purchasedwi*
grant funds, which acknowledge the State as providing funds far ihTprofect S^n ^
Prov,ded by the Department must be approved by the US^S^S^
? KRMINATION FOR CAIISf_ Grantee's failure to comply with any of the terms
l!meit tah's.Grant.
.. Agreement
gemnt shall be a sufficient-basis to suspend or tenrtnitoSS
^lS elaSS T 7!J? °la"
Tk rec7!J? l" grant fands disbursed to the Grantee.
Grantee A failure
fil to
ITtlL ♦tH* tH* te*mS °f ?ls Grant t&e*™** âll also be a sufficient basis to
suspend or terminate any other grant(s) issued to the Grantee by the Department and
rminat th () i
to reject future grant requests for the Grantee. ^parimcru ana
y f 'ln5WSbut The
AWS- Grantee ist rec*uired t0 comply with all
lawS' mcludln5 "mited to th
no* "mitd the fili
filing off any and al
IS ^,Vf^ ,the event that a Grantee is delinquent in filing and/or paying
any fede al, state and/or local taxes, the Department shall disburse grant funds only §
the Grantee enters into an installment payment agreement with said tL authority and
remains in good standing therewith. Grantee is required to tender a copy of any such
installment payment agreement to the Department. In no event may Granted* SSL
grant funds to discharge outstanding tax liabilities. The exeS oMhte Snt
Agreement by the Grantee is its certification that it is current as to the fiL and
payment of any federal, state and/or local taxes applicable to Grantee g
THE UNDERSIGNED IS AUTHORIZED ON BEHALF OF GRANTEE TO AND
Z5^£822S£&"ma T0 C0MPLY=
EXHIBIT 1
The Project described in Part ill and funded under this Grant Agreement, is subject to
review by the external agency(ies) indicated in Section 2.2 hereof Grantee must comp y
with requirements established by said agency(ies) relative to their respective reviews
Any requirements communicated to the Department shall be incorporated into this
Agreement as ollows: (I) as an attachment to this Exhibit 1 at the time of grant
execution; or (.,) if received from the applicable agency(ies) subsequent to execution
. as an addendum to this Agreement. The Grantee is contractually obligated to comply
with such requirements. . wwnpiy
Grantee is responsible for coordinating directly with the applicable external agencyfies)
relative to said reviews. Except as specifically provided below, the Department's
obligation to disburse funds under this Grant Agreement is contingent upon notification
by the applicable agency(ies) that all requirements applicable to the Project have been
satisfied Upon receipt of said notification, disbursement of the grant funds shaM be
authorized in accordance with the provisions of Section 2.3 hereof.
Prior to notification of compliance by the applicable external agency(ies), the Grantee

may request d.sbursement of funds only for the following purposes administrative
contractual, legal, engineering, or architectural costs incurred wn?c^ are nTessaryto*
pance by the Grantee of requirements established by the extermS
allow for comphance
agency(ies). FUNDS WILL NOT BE DISBURSED
URSED FOR
FOR LAND
LAND ACQUISITION OR ANY
TYPE OF CONSTRUCTION OR OTHER ACTIVITY WHICHI PHYSICALlTImPACTS ThI
PROJECT SITE PRIOR TO RECEIPT BY THE DEPARTMENT OF THE REOUIJfd
NOTIFICATION FROM ALL APPLICABLE AGENCIES REQUIRED
PART III
SCOPE OF WORK
Section 1. Public Benefit
The Grantee is a nonprofit corporation providing instruction to the community in basic

hands-on life supporting first aid including cardiopulmonary resuscitation. Through the
Blue Angels program, the Grantee helps to promote the moral, ethical and
compassionate duty to act in another's behalf. This program will be enhanced by the
purchase of equipment and materials funded by this Grant.
3173 people will be trained as a result of this project.
Section 2. Grant Tasks
2.1 The Grantee will use Grant funds in accordance with Part I, Budget.
2.2 The Grantee shall continue to provide the programs and services specified in Section
1, above, for the term of the Grant Agreement.
PART IV
TERMS AND CONDITIONS GOVERNING GRANT
(Non-governmental Entities)
4.1 APPLICABLE TIME LIMITATIONS
SL ^f'!*10" °f.Perf°rmance A" activities described in Part III hereof which are
chargeable to grant funds provided by this Agreement, must be completed by the grant
period end date set forth in the Notice of Grant Award.
(ii) Expenditure of Grant Funds. AM grant funds provided under this Agreement must
be expended or legally obligated by the grant end date set fort i heNotS ofGân
Award Grant funds not expended by the grant end date must Te returned to the
Department in accordance with directions provided by the Department
4.2 INTEREST ON GRANT FUNDS. Any interest earned on grant funds provided under
£?feJment mUSt be accounted f°r ^d returned to the Department
with the direct.ons provided by the Department. P^mem inâccordance
accordance
BEfFUNDV° THE DEPARTMFNT. Any refunds (unliquidated grant balance
4'4 BUDGET/SCOPE OF WORK MODIFICATION
P' The Grantee must obtain Prior writt*n approval from the
DLrtmLVhl0^
Department before (PHart IU)- The
changing any GrantSe
of the mUSt °btainspecified
activities prior written aPP™'
in Part from are
III which the
^tne^n?
-a^t^?'
activities by th ^T
Gt T^"
by the Grantee which ^ *« '" ^
hh
are inconsistent r6SUltS
with the in *•setpil^-nVS
purpose forth in the
Appropriation authorizing the grant awarded under this Agreement are not permissible
*ECh0RD'NG/*EP0RTINfi REQUIREMENTS The Grantee is accountable
d'sbu!-sed under this Grant. The Grantee's financial management system
eflSSvi
T? *h ^"t
rnnSLf h
^ ^^ CUne^ and comP|ete disclosure S'Te
PrOrid.e,d Under this Aêment. The Grantee shall maintain
effective control and accountability over all funds disbursed and, equipment, property
nl^HTSaCqZed With grant fundS- The Grantee sha" keeP records suffiSSIt to
ZTJn! hanmg °f fU^S t0 a l6Vel °f exPenditure adequate to insure that funds have
been expended in accordance with the terms of this Agreement.
4.6 GRANT DELIVERABLES. The Grantee will submit the following Grant deliveries
in accordance with the Grant Agreement provisions referenced herein:
(i) Project Status and Expenditure Reports (Section 2.5)
(ii) Financial Close-out Package (Section 5.4B); and
(iii) Audit (if applicable) (Section 2.1 and Section 5.4C)
4.7 PROCUREMENT OF CONSTRUCTION AND PRQFFSSIONAL SERVirrc;

ACQUISITION OF EQUIPMENT OR_LAND. The Grantee shall procure all construction
and professional services, and acquire land, equipment and materials financed in whole
or in part with grant funds provided hereunder, through written, contractual
agreement(s), which specify the rights and obligations of both parties relevant to the
specified transaction
4-8 DUE DILIGENCE IN EXPENDITURE OF FUNDS. Grantee shall ensure that grant
funds are expended in accordance with the following principles:
(i) Grant expenditures should be made in accordance with generally accepted sound
business practices, arms length bargaining, applicable federal and State laws and
regulations, and the terms and conditions of this Agreement;
(ii) Grant expenditures should not exceed the amount which would be incurred by a
prudent person under the circumstances prevailing at the time the decision is made to
incur the costs; and
(iii) Grant expenditures should be consistent with generally accepted accounting

principles.
4-9 LEGAL COMPLIANCE. In addition to complying with the statutes and regulations
specifically referenced in this Agreement, the Grantee is responsible for determining the
applicability of and complying with any other laws, regulations, ordinances, etc. which
govern the Grantee's performance of the activities described in Part III hereof, including,
but not limited purchasing/procurement rules, to the Prevailing Wage Act (820 ILCS
130/0.01 et seq.) and the Interagency Wetlands Policy Act (20 ILCS 830/1 et. seq.).
PARTV
GENERAL PROVISIONS
5.1 GRANTEE AUTHORITY: INDEPENDENCE OF GRANTEE PERSONNEL: GRANTOR

AUTHORITY: GOVERNING LAW.
A. Grantee Authority. The Grantee warrants that it is the real party in interest to this
Agreement, that it is not acting for or on behalf of an undisclosed party, and that it possesses
legal authority to apply for this grant and to execute the proposed program or project
described in Part III hereof. Grantee's execution of this Agreement shall serve as its
attestation that Grantee has read, understands and agrees to all provisions of this Agreement
and to be bound thereby. Grantee further acknowledges that the individual executing this
agreement is authorized to do so on Grantee's behalf.
B- Independence of Grantee Personnel. All technical, clerical, and other personnel

necessary for the performance required by this Agreement shall be employed, or contracted
with, by Grantee, and shall in all respects be subject to the rules and regulations of Grantee
governing its employees. Neither Grantee nor its personnel shall be considered to be the
agents or employees of the Department.
C. Grantor Authority. The Department and its payroll employees, when acting pursuant to
this Agreement, are acting as State officials in their official capacity and not personally or as
the agents of others.
D. Governing Law. This Grant is awarded in the State of Illinois for execution within the
State of Illinois. This Agreement shall be governed by and construed according to Illinois law
as that law would be interpreted by an Illinois Court. Where there is no Illinois law on a
particular subject or issue, then the applicable law will be applied as it would be if interpreted
and applied by an Illinois court.
5-2 SCOPE OF WORK. In consideration for the grant funds to be provided by the
Department, the Grantee agrees to perform the project described in Part III hereof and to
prepare and submit to the Department the reports and other deliverables described in this
Agreement.
5.3 FISCAL RESPONSIBILITIES
A- Non Appropriation Clause. Payments pursuant to this Agreement are subject to the
availability of applicable Federal and State funding from the Department and their
appropriation and authorized expenditure under state law. Obligations of the State will cease
immediately without penalty or liability of further payment being required if in any fiscal year
that this Agreement is in effect the Illinois General Assembly or Federal funding source fails to
appropriate or otherwise make available sufficient funds for this grant.
The Grantee hereby is given actual knowledge of the fact that pursuant to the State Finance
Act, 30 ILCS 105/30, payments under this grant are contingent upon there existing a valid
appropriation therefor and that no officer shall contract any indebtedness on behalf of the
State, or assume to bind the State in an amount in excess of the money appropriated, unless
expressly authorized by law. If this is a multi-year grant, it is void by operation of law if the
Department fails to obtain the requisite appropriation to pay the grant in any year in which
this Agreement is in effect.
B- Total Amount of Grant Limited. The Grantee expressly understands and agrees that the
total financial obligation of the Department under this Agreement shall not exceed the total
grant amount set forth on the Notice of Grant Award and the Grantee agrees expressly to fully
complete the Scope of Work specified in this Agreement and all other obligations under this
Agreement within the stated total consideration.
c- Delivery of Grantee Payments. Payment to the Grantee under this Agreement shall be
made payable in the name of the Grantee and sent to the person and place specified in the
Notice of Grant Award. The Grantee may change the person to whom payments are sent, or
the place to which payments are sent by written notice to the Department signed by the
Grantee. No such change or payment notice shall be binding upon the Department until ten
(10) business days after actual receipt.
5.4 RECORDS RETENTION AND ACCESS TO RECORDS: PROJECT CLOSEOUT:

ACCOUNTING: AND AUDIT REQUIREMENTS.
A- Records Retention. The Grantee is accountable for all funds received under this
Agreement and shall maintain, for a minimum of three (3) years following the later of the
expiration or termination of this Agreement, adequate books, records, and supporting
documents to verify the amount, recipients and uses of all disbursements of funds passing in
conjunction with this Agreement. This Agreement and all books, records and supporting
documents related hereto shall be available for inspection and audit by the Department, the
Auditor General of the State of Illinois, or any of their duly authorized representatives, and the
Grantee agrees to cooperate fully with any audit conducted by the Auditor General or the
Department. Grantee agrees to provide full access to all relevant materials and to provide
copies of same upon request. Failure to maintain books, records and supporting documents
required by this Section 5.4 shall establish a presumption in favor of the Department for the
recovery of any funds paid by the Department under this Agreement for which adequate
books, records and supporting documentation are not available to support their purported
disbursement.
If any of the services to be performed under this Agreement are subcontracted, the Grantee
shall include in all subcontracts covering such services, a provision that the Department and
the Auditor General of the State of Illinois, or any of their duly authorized representatives, will
have full access to and the right to examine any pertinent books, documents, papers and
records of any such subcontractor involving transactions related to this Agreement for a
period of three (3) years from the later of the expiration or termination of this Agreement.
B- Grant Closeout. In addition to any other reporting requirements specified in this

Agreement, the Grantee shall complete and submit a final Grant Closeout Report on forms
provided by the Department, within time limits established by the Department, after the
expiration or termination of this Agreement. The Grantee must report on the expenditure of
grant funds provided by the State, and if applicable, the Grantee's required matching funds.
The Grantee is responsible for taking the necessary steps to correct any deficiencies disclosed
by such Grant Closeout Report, including such action as the Department, based on its review
of the Grant Closeout Report, may direct.
In accordance with the Illinois Grant Funds Recovery Act, 30 ILCS 705/1 et seq., the Grantee
must, within 45 days of the expiration or termination of this Agreement, refund to the
Department, any balance of funds which is unobligated at the end of the Grant term specified
in the Notice of Grant Award. For purposes of preparation of grant closeout forms, the
determination of allowable expenditures and excess grant funds shall be based on the premise
that the total Grantee compensation under this Agreement shall not exceed the amount
specified in the Notice of Grant Award.
C. Audit Requirements. If required by Part II of this Grant Agreement, the Grantee shall be
required to have an audit conducted in accordance with the following terms:
a. State Audit Requirements;
(i) The audit shall be conducted by a certified public accountant who is licensed by
the State of Illinois to conduct an audit in accordance with Generally Accepted
Auditing Standards.
(ii) Grant funds shall be included in the Grantee's annual audit, unless the
Department authorizes the Grantee to have a grant-specific audit conducted.
(iii) Upon completion of an audit, an audit report shall be issued and the Grantee
. shall provide the Department with a copy of such audit report.
(iv) The Grantee shall provide the Department with a copy of an audit report within 30
days of the Grantee's receipt of such audit report, but in no event later than nine
months following the end of the period for which the audit was performed. The
Grantee shall send the audit report to the Department at the following address:
Illinois Department of Commerce and Community Affairs

Division of Audits
620 East Adams
D- Worker's Compensation Insurance. Social Security. Retirement and Health Insurance

Benefits, and Taxes. The Grantee shall provide Worker's Compensation insurance where the
same is required and shall accept full responsibility for the payment of unemployment
insurance, premiums for Workers' Compensation, Social Security and retirement and health
insurance benefits, as well as all income tax deduction and any other taxes or payroll
deductions required by law for its employees who are performing services specified by this
Agreement.
5.5 TERMINATION: SUSPENSION
A. This Agreement may be terminated as follows:

1. Due *° Loss of Funding. Obligations of the State will cease immediately without
penalty of further payment being required if in any fiscal year the .Hinds Genera Assemblyo
Federal funding source fa.ls to appropriate or otherwise make available sufficient fundsTor th°s
2ST * h . V!^ ?6 Department suffers such a loss of funding in fu, or in pa?t the
ol olnZ tS^J"Q the,Granhtee written notice wh*<* shall set forth the effective date of uN
a°ndPS'St^C" " J
?;hFB0rt CaUSe' lf *he DePartment determines that the Grantee has failed to comply with
hp L 7' C°ndlt'onfs °r Pôvis-ons of this Agreement, or any other Agreement executed
Dpnlrtmpn?
Department
1 ^ ^J™?"' inciudine any W'fcable rules or regulations, the
may terminate th.s Agreement in whole or in part at any time before the
expiration date of th.s Agreement. The Department shall notify the Grantee in writing of the
inv ro,t?r,S!f fhmm«tl0.n an? lhe f6CtiVe date °f the termjnation. Grantee shall not incur
any costs after the effective date of the termination. Payments made to the Grantee or
recovery by the Department shall be in accord with the legal rights and liabilities of the
parties.
In the event of termination for cause, Grantee shall also be subject to any other applicable
provisions specified elsewhere in this Agreement.
Termination for cause may render the Grantee ineligible for consideration for future grants
from the Department. e
3. For Convenience. The Department or the Grantee may terminate this Agreement in
whole or in part when the Department and the Grantee agree that continuation of the program
objectives would not produce beneficial results commensurate with the further expenditure of
funds. The Department and the Grantee shall agree upon termination conditions including the
effective date and, in the case of partial termination, the portion to be terminated The
Grantee shall not incur new obligations for the terminated portion after the effective date and
shall cancel as many outstanding obligations as possible. The Department shall allow full
credit to the Grantee for the Department's share of the non-cancelled obligations, if properly
incurred by the Grantee prior to termination.
B. Suspension. If the Grantee fails to comply with the specific conditions and/or general
terms and conditions of this Agreement, the Department may, after written notice to the
Grantee, suspend this Agreement, withhold further payments and prohibit the Grantee from
incurring additional obligations of grant funds, pending corrective action by the Grantee or a
decision to terminate this Agreement. Department may determine to allow such necessary
and proper costs which the Grantee could not reasonably avoid during the period of
suspension provided that the Department agrees that such costs were necessary and
reasonable and incurred in accordance with the provisions of this Agreement.
Section 5.6 INDEMNIFICATION
A. Nongovernmental entities. The Grantee agrees to indemnify and hold the Department
and/or the State of Illinois, and its officers, agents, or employees harmless from and against
any and all claims, and actions, including but not limited to, attorneys' fees, costs and
interest, based upon and arising out of any services performed under this Agreement by the
Grantee and its officers, employees, agents, independent contractors, subcontractors
subrecipients. volunteers, or other associates. The Grantee shall further indemnify and hold
the Department and/or the State of Illinois and/or its officers, agents and employees
harmless from and against any and all liabilities, demands, claims, damages, suits costs fees
and expenses incident thereto, for injuries or death to persons and for loss or damage'to or
destruction of property because of negligence, intentional acts or omissions on the part of
Grantee, its officers, employees, agents, independent contractors, subcontractors
subrecipients, volunteers or other associates, arising out of any services performed under this
Agreement.
The Grantee further agrees to indemnify, save and hold harmless the Department, its officers
agents and employees against any liability, including costs and expenses associated with the
violation of general, proprietary rights, copyrights or rights of privacy of third parties arisng
°11 heP^l.cat,on translation, reproduction, delivery, performance, use orPd"spo,i5on^
containedterZ °' ^ ^ Agreement or an* libelous °r any unlawful matter
B. Governmental Entities. In the event that the Grantee is a Governmental Entity it will
S2l™1?H/nd
Federal and/or 5'? ml6.SS the Department
State constitutions(s) as set out herein to the extent authorized by
and/or laws.
Dursu^TTo thk/L "!"• 3ny d.erTd °r daim relating t0 the transactions or activities
pursuant to this Agreement is made known to either party, the Department and/or the
Grantee will notify the other party to this Agreement in writing in an expedient manner.
Y MnnincATlONS:
f■ n t °peration °f Law" This Agreement

geement is
is subject
subject to
to such
such modifications
modifications as
as
lnm?rah.o T ?i IermmeS
mmeS ™y * required byb chanSes
h ini Federal
Fd or State law or regulations
applicable to this Agreement. Any such required modification shall be incorporated into and
be part of this Agreement as if fully set forth herein. The Department shall timely notify the
Grantee of any pending implementation of or proposed amendment to such regulations of
B. Budget Modifications, Budget modifications shall be made in accordance with any

applicable provisions as specified elsewhere in this Agreement.
f/ DiscretionarY Modifications. If either the Department or the Grantee wishes to modify

the terms of this Agreement other than as set forth in Sections A and B above, written notice
of the proposed mod.f.cat.on must be given to the other party. No modification will take effect
npnLrtmtnafgrefd ♦!." r"^ by b°th the DePartment ™<* the Grantee, except that if the
Department notifies the Grantee in writing of a proposed modification without the prior written
thpPoNpnt >a,nte+!' !ai!Ze °f the Grantee t0 object in writine- specifying the reasons for
the object ons, within thirty (30) calendar days from the date of the Department's notice to the
Grantee of such proposed modification, the modification will be deemed to be approved by the
Grantee. The Department's notice to the Grantee shall contain the Grantee name, Grant
number, modification number, purpose of the revision and signature of the Department's
director.
5-8 CONFLICT OF INTEREST; INTEREST OF PIIRUC OFFICIAI

BONUS/COMMISSION PROHl
Ln^lm ,
agents, employees
w, ■ Grant6e Sha" eStabHsh safeeuards to prohibit officers, directors,
and fam.ly members from using positions of employment for a purpose
hat is. or g,Ves the appearance of, being motivated by a desire for a private gain for
themselves or others particularly those with whom they have family business or othe ties
Safeguards, evidenced by rules or bylaws, shall be established to prohibit persons from
engaging in actions wh.ch create or which appear to create a conflict of interest as described
herein or in Section 2.6 of this Agreement. aescriDea
B- Interest of Public Officials/Employee
(0 Governmental Fntity If the Grantee is a governmental entity, the Grantee certifies

that no officer or employee of the Grantee and no member of its governing body and no other
public official of the locality in which the program objectives will be carried out who exerdses
such
such ob IT' °r shall
objectives rheSrSi+bilitieS
participate ininthe
anyr6VieW °r approval
decision relating of
to the
anyundertaking or carryingunder
contract negotiated out 0a
g y tact negotiated under a
Xamgrant
oXh WhJCh affeCtS hiS/h6r PerS°l
PerS°nal itt
interest th
or the i
interest f
of fny ^
orporaôn
f'nancia iL°rUtSH°Cia'°n *." whicfh .he/she * directly or indirectly interested, or has any
such contract ' " '" SUCh C°ntraCt °r in the WOrk to be Perfor™d <"der
(ii) Nongovernmental Fntity. If the Grantee is a nongovernmental entity, it shall comply
with the prov.sions of Section 2.6 hereof relative to conflict of interest.
iSfStehCti0An 5'8 (a"d ^ fOr non-S™"™Tiental entities) may result in suspension

or
of this Agreement, and recovery of grant funds provided hereunder. Vblators
^"5^'other applicable state laws and subject to actions up to
* Hiri"R s,tate Employees Prohibitpri, No State officer or employee may be hired to

thrn LTtherVICeS.Unier th'S ASreement' or be Paid with funds derived directly or indirectly
through this grant without the written approval of the Department.
5.9 APPLICABLE STATUTES.
A. Grantee Responsibility. All applicable Federal, State and local laws, rules and
wTE ZlZZTl* theP^rmance re<>uired by Grantee shall apply to this Agreement and
will be deemed to be included in this Agreement the same as though written herein in full
Grantee is responsible for ensuring compliance with all applicable laws, rules and regulations
mclud.ng, but not limited to those specifically referenced herein. Except where expressly
?' La"d Trust/Beneficial Disclosure Act ( 7fifi n rs 405/2.1V No grant award funds shall
be paid to any trustee of a land trust, or any beneficiary or beneficiaries of a land trust for any
purpose relat.ng to the land which is the subject of such trust, any interest in such land
improvements to such land or use of such land unless an affidavit is first fL with the
TTTl^r" ^ ^^ * * ld address lSj
C1H H'yr'f Prese"?ti(>" Act (20 ILCS 3420/1 et seq.). The Grantee will not expend funds
o utHi»tSi^fTT\WlllCh
»,Xi n ♦
r6SUlt ^ ^ destruction- alterati°n- renovation, transfer or safe
Jistonc properly, structure or structures, or in the introduction of visual
resu^n^L
result in the rZP
change in thelehment!
the character*or* use
^^ of anyPr°Perty' StrUCture or structures, which vii
historic property.
D, State of Illinois Discrimination Laws m* |LCS B/1-1M, -t c, } In carrying out the

performance required under this Agreement, the Grantee shall compy with af applicable
provisos of the I Imois; Human Rights Act, and rules and regulations promulgate? by the
ZJT?™?
?? °f HUman
, RightS> Prohibitine un'awful discrimination in fmployment
g> Pbitine
i™ t0 HC°mP y W'th a" aPP|icable Pr°vi*i°ns of the Illinois
Illinoi Human
H Riht Act.
Rights At or
G?aPntt t 'n ?S a"d/eg,u'atlons Pro^"'gated thereunder, may result in a determination ha
Grantee is mel.g.ble for future contracts or subcontracts with the State of Illinois or any of its
poht.ca{ subdivisions or municipal corporations, and this Agreement may be canceled or
voided in whole or in part, and such other sanctions or penalties may be imposed or remedies
invoked as provided by statute or regulation. ".puêa or remedies
Lu^H^h AP ,,f 80/1' 6t> *«*•>• Grantee wi" make th^ certification
required in this Agreement and will comply with all of the provisions of the Drugfree Workplace
Act that are applicable to the Grantee. False certification or violation of the requirements of
the Drugfree Workplace Act may result in sanctions including, but not limited to, suspension
of grant paymentsi termination of this Agreement and debarment of contracting or grant
opportun.t.es with the State for at least one (1) year but not more than five (5) years
[' freedom of Information Act (5 ILCS 140/1 et. seq.). Applications, programmatic reports
and other mformation obtained by the Department under this Agreement shall be
administered pursuant to the Freedom of Information Act. The Department shall give Grantee
timely notice in the event it receives a request for information submitted by Grantee relative
to this Agreement.
5.10 MISCELLANEOUS PROVISIONS.
A. Waivers. A waiver of any condition of this Agreement must be requested in writing No

W^6rn any condltlon of this Agreement may be effective unless in writing from the Director
oT the Department.-
B Assignment. The benefits of this Agreement and the rights, duties and responsibilities of
the Grantee under this Agreement may not be assigned (in whole or in part) except with the
thTr^nr.i^.0lthe Department actin6 through its Director. Any assignment by
the Grantee m violation of this provision renders this Agreement voidable by the Department.
C Severability Clause, If any provision under this Agreement or its application to any
person or circumstances is held invalid by any court of competent jurisdiction, this invalidity
« t th Hhany ° j*1" provision or its application of this Agreement which can be given
effect without the invalid provision or application.
D. Integration Clause. This Agreement, with attachments, as written, is the full and
complete agreement between the parties and there are no oral agreements or understandings
between the parties other than what has been reduced to writing herein. B
E. Comptroller Filing Notice, The Grantee expressly understands that whenever applicable
a copy of this Agreement and any modification, cancellation or renewal is required to be filed
by the Department with the State Comptroller.
h;roSUbh°,?traflandKGrantS< The Grantee's services> duties and responsibilities specified

herein shall not be subcontracted or subgranted by the Grantee without prior written approval
of the Department, unless such subcontracts or subgrants are provided for elsewhere in this
an^rTh. ^^ s"bc°nJracts or subgrants shall be subject to, and conform with, ail
2X£? t I ♦ a 'aWSl 3nd Sha" sPecifical|y Pr°vide that subcontractors or
subgrantees are subject to all of the terms and conditions of this Agreement
Nov-,4-2000 17:07 Froffl-OCCA .L F.RST 217.S5M883 ^ ?m/m
PART VI
STATE OF ILLINOIS REQUIRED
CERTIFICATIONS
The Grantee makes the following certifications as a condition of this Agreement. These
certifications are required by State statute and are in addition to any certifications required
by any Federal funding source as set forth in this Agreement. Grantee's execution of this
Agreement shall serve as its attestation that the certifications made herein are true and
correct.
6.1 COMPLIANCE WITH APPLICABLE LAW. The Grantee certifies that it shall comply with all
applicable provisions of Federal, State and local law in the performance of its obligations
pursuant to this Agreement.
6-2 CONFUCT OF INTEREST. The Grantee certifies that it has no public or private interest
direct or indirect, and shall not acquire directly or indirectly any such interest which does or
may conflict in any manner with the performance of Grantee's services and obligations under
this Agreement.
6-3 mP-Riqq|NG/BID.ROTATlNG. The Grantee certifies that it has not been barred from
contracting with a unit of State or local government as a result of a violation of Section 33E-3
or 33E-4 of the Criminal Code of 1961 (720 ILCS 5/33 E-3 and 5/33 E!-4).
6-4 PEFAULT ON EDUCATIONAL LOAN. The Grantee certifies that this Agreement is not in
violation of the Educational Loan Default Act (5 ILCS 385/3) prohibiting certain contracts to
individuals who are in default on an educational loan.
6.5 AMERICANS WITH DISABILITIES ACT. The Americans with Disabilities Act (ADA) (42
U.S.C. 12101 et. seq.) and the regulations thereunder (28 CFR 35.130) prohibit
discrimination against persons with disabilities by the State, whether directly or through
contractual arrangements, in the provision of any aid, benefit or service. As a condition of
receiving this grant, the Grantee certifies that services, programs and activities provided
under this Agreement are, and will continue to be, in compliance with the ADA.
6.6 DRUGFREE WORKPLACE ACT The Grantee certifies that:
A> -A- '*is a Corporation, Partnership, or other entity (other than an individual) with 24
or fewer employees at the time of execution of this Agreement.
B) That the purpose of this grant is to fund solid waste reduction.
C) It is a Corporation, Partnership, or other entity (other than an individual) with 25

or more employees at the time of execution of this Agreement, or
D) That it is an individual.
If Option "Au or "B" is checked this Agreement is not subject to the requirements of the Act.
PART VI
CERTIFICATIONS
The Grantee makes the following certifications as a condition of this Agreement

' Sih i S?Ulr-d ^ St3te Sta/Ute an(J 3re in addition t ^ÊZf
g S°U.rCe " S6t f0rth in this Agrwment. Grantee's execution of this
JorrecT ""* " ' atteStation that the unifications made herein are true and
APPLICABi F ' AW ™e Grantee certifies that it shall comply with all

Federal ^ "* ^ ^ ln "» f ** ^
6-2 CONFLICT OF INTERFST The Grantee certifies that it has no public or private interest
mô°nrf,in?ireCt' and Sha" nOt aCQUire
t^s Agreemen" ^ ^^
direCtly °r indirect|y anV such interest which "oeso;
Performan« of Grantee's services and obligations under
6.3 BID.RIGGING/BID.ROTATING. The Grantee certifies that it has not been barred from
or^fff tWKlthra Unit ^State °r '°Cal g°vernment as a result of a violation of Sect Z33M
or 33E-4 of the Criminal Code of 1961 (720 ILCS 5/33 E-3 and 5/33 E-4).
that this ASreement is

indiv d°una.°s who
individuals who ar7CatH°fnal|,L°an
are in default on an°e!!Ult ACt (5 loan.
educational 'LCS 385/3) Pr°hîting certain contracts to
6.5 AMERICANS WITH DISARM .TIPS rtCT. The Americans with Disabilities Act (ADA) (42
USC. 12101 et. seq.) and the regulations thereunder (28 CFR 35.130) proh bit
discnmma ion against persons with disabilities by the State, whether directly or through
,mHerJ!? a'S ^ '♦
under this Agreement are,
aJntee Certifies that services- P^grams and activities provided
and will continue to be, in compliance with the ADA.
6-6 DRUGFREE WORKPLACE ACT The Grantee certifies that:
A) It is a Corporation, Partnership, or other entity (other than an individual) with 24


C) It is a Corporation, Partnership, or other entity (other than an individual) with 25
If Option "A" or "B" is checked this Agreement is not subject to the requirements of the Act.
s?s
Grantee will provide a drugfree workplace by:
(a) Publishing a statement:
(i) Notifying employees that the unlawful manufacture, distribution disoensins

Sî^ * ^^ ^^ ~* " i ^'blSTT'S
00 pS5ithe aCti°nS that Wi" be tak6n 3gainSt emP|oye" for violations of such
., as a condition of employment on such erant th*»
(A) abide by the terms of the statement; and
(B) orrurriia6 B™plover f any Criminal drug statute conviction for a violation
occurring in the workplace no later than five (5) days after such conviction.
(b) Establishing a drug free awareness program to inform employees about:

(i) the dangers of drug abuse in the workplace;
(ii) the Grantee's policy of maintaining a drug free workplace;
(iii)any available drug counseling, rehabilitation and employee assistance programs; and
(iv)the penalties that may be imposed upon an employee for drug violations.
(c) Providing a copy of the statement required by subparagraph (a) to each employee
rn7haegworkPlacePerfOrmanCe °f ^ ^ ^ t0 P°St the statement in a Prominent place
(d) Notifying the granting agency within ten (10) days after receiving notice, under part (B) of
oaram-anh r..rt nf ...h..^,, ,^ aboye> from an emp|oyee Qr otherwjse W K } °
(e) Imposing a sanction on, or requiring the satisfactory participation in, a drug abuse
assistance or rehabMitation program by any employee who is so convicted, as required by
Section 5 of the Drugfree Workplace Act, 30 ILCS 580/5. «Hu.rea oy
(f) Assisting employees in selecting a course of action in the event drug counseling
treatment and rehabilitation are required and indicating that a trained referral team is in
place.
(g) Making a good faith effort to continue to maintain a drugfree workplace through
implementation of the Drugfree Workplace Act, 30 ILCS 580/5.
If Grantee is an individual, it certifies that it will not engage in the unlawful manufacture
distribution, dispensation, possession, or use of a controlled substance in the performance of
this Agreement.
6.7 ANTI-BRIBERY. The Grantee certifies that neither it nor its employees have been
convicted of bribing or attempting to bribe an officer or employee of the State of Illinois nor
has Grantee or any of its employees made an admission of guilt of such conduct which' is a
matter of record as defined in the Illinois Procurement Code (30 ILCS 500/50-5).
6-8 D'SCRIMINATION/ILLINOIS HUMAN RIGHTS A<rr The Grantee certifies (i) that it will
not commit unlawful discrimination in employment in Illinois as that term is defined in Article
2 of said Act; (u) that it will comply with the provisions of Article 5 of the Act regarding equal
employment opportunities and affirmative action; and, (iii) that it will comply with policies and
procedures established by the Department of Human Rights under Article 7 of the Act
regarding equal employment opportunities and affirmative action.
The Grantee further certifies that, if applicable, it will comply with "An Act to prohibit
discrimination and intimidation on account of race, creed, color, sex, religion, physical or
mental handicap unrelated to ability or national origin in employment under contracts for
public buildings or public works." (775 ILCS 10/0.01 et. seq.)
6'9r SEXUAL HARASSMENT. The Grantee certifies that it has written sexual harassment
policies that shall include, at a minimum, the following information: (i) the illegality of sexual
harassment; (n) the definition of sexual harassment under State law; (iii) a description of
sexual harassment, utilizing examples; (iv) the Grantee's internal complaint process including
penalties; (v) the legal recourse, investigative and complaint process available through the
Department of Human Rights and the Human Rights Commission; (vi) directions on how to
contact the Department and Commission; and (vii) protection against retaliation as provided
by Section 6-101 of the Illinois Human Rights Act (775 ILCS 5/2-105 (B)(5). A copy of the
policies shall be provided to the Department upon request.
6*10 INTERNATIONAL ANTI-BOYCOTT CERTIFICATION The Grantee hereby certifies that

neither the Grantee nor any substantially owned affiliate company of the Grantee is
participating or will participate in an international boycott, as defined by the provisions of the
U.S. Export Administration Act of 1979, or as defined by the regulations of the US
Department of Commerce, promulgated pursuant to that Act (30 ILCS 582/1 et seq.).
PAM MCDONOUGH
DIRECTOR
June 22, 2002
Ms. Carol Spizzirri

Pres/Founder
4825 N Scott St Ste 74A
Re: Grant No. 01-124154
Dear Ms. Spizzirri:
Enclosed is your fully executed copy of the modification to

your grant agreement between your agency and the Department of
Commerce and Community Affairs (DCCA). Please retain this
modification along with your grant agreement for future reference
If you have any questions regarding this modification,

please contact your DCCA Grant Manager.
Sincerely,
Pam McDonough
Director
Enclosure
•*•*■•« *•«» m*Mwmm fmm+tt* Mstt •! M

GRANT AGREEMENT MODIFICATION /'~"'
1. Grant Recipient: JUN 11 2002

2. Grant Agreement: 01-124154 3. Modification No: 001
4. Current Grant Period: 07/01/2000 to 06/30/2002
5. Funding Source: COMM. ASSIST. - LEGISLATIVE
6. Purpose of Modification:
Change in Other Section in Accordance with Attachment i*"^"

TO CHANGE THE FOLLOWING:
CHANGE IN OTHER SECTION IN ACCORDANCE WITH ATTACHMENT
BUDGET MODIFICATION
Except as modified herein, the basic Agreement remains unchanged,

including all prior modifications as agreed to by the parties
7. This modification has the following effect on the total amount

of the Grant:
No Change
8. Signature:
Grantee:
Authorized Signature for Grantee
Name and Title
State of Illinois Department of Commerce and Community Affairs
*y- raw lMcCWW*_. ^ a

Pam McDonough, Director " Date/\
06/10/2002 10:30:28
Transmittal Cover Sheet for
Illinois FIRST
Request for Modification/Waiver
GRANTEE NAME: ÂUiT A Life 6>t/tUhAnoiJ. /*/£ .
DCCA GRANT #: Of -/
GRANT EXPIRATION DATE: Pb1 3o /
Grant Manager Certification

The Illinois FIRST grant manager or bureau coordinator responsible for this project hereby
certifies the following (check ALL that apply to the modification or waiver):
LxThe grant has not yet expired as of this submittal.
Q The Grantee is requesting a change to the scope of work. I certify that the original scope of
work referenced in the attached Request for Modification/Waiver form is identical to the scope
of work that was included in the grant agreement or subsequent modification(s).
□"The Grantee is requesting a change to the budget. I certify that the original budget included
on the attached Request for Modification/Waiver form is identical to the budget that was
included in the grant agreement or subsequent modification(s).
Q The Grantee is requesting a date extension.
□ The Grantee is requesting a change other than those enumerated above, which requires Legal
review.
□ The Grantee is requesting a waiver from the audit provisions in the Grant Agreement.
(Division of Audits' Approval of this Waiver: \
Q This request was initiated by DCCA Accounting.
Q This request was initiated as a result of a DCCA Monitoring finding.
□ The proposed mod/waiver will affect a building, land or location other than that originally
submitted for environmental review.
O The proposed changes are within bond guidelines (this is applicable to bond-funded projects
onIyz
Grarjt Manager or Bureau Coordinator signature Date '
DCCA Legal Action
\fi Modification Approved • Grant manager is authorized to enter the modification into GRS and
transmit modification package to Accounting.
□ Modification Denied (see attached)
□ Approved as a Waiver • Grant manager is responsible to transmit a copy of this approved

waiver to the Grantee and to DCCA Accounting.
Legal signature 5 Date

—. .»_ r. «... _ , u
hU.

Illinois FIRST Program
REQUEST FOR MODIFICATION/WAIVER*
GRANTEE NAME: S»\/e A Lies f^DJJhAYlCM

^ i IkfC .
DCCAGRANT**: <Di - !&*+ 14+ (the-Agreement")
GRANT EXPIRATION DATE: 0k I 40 I £&/
D A. SCOPE OF WORK Please briefly detail why the modification to the scope of work is necessary. (A
copy of the original scope showing all proposed revisions must be attached to this request). Note: Revisions
will not be considered if they are inconsistent with the legislation authorizing the grant.
B. BUDGET Using the form on the reverse, please list the original budget items and the requested revised
budget. Note: Requests for an increase in the total grant amount will be denied.
n r PA.7fc extension. Grouse requires additional time to complete the perfbrnianceHJescfibed in Pan Hr- — 1
of the agreement for which grant funds are provided, and requests that it be allowed until , 200_, to
complete such performance. Grantee acknowledges that it has expended/legally obligated grant funds in the
performance required by the grant during the original gram term and that if granted, the extension of time cannot
exceed two (2) years.
CT D. OTHER Please attach a separate page identifying the provision(s) that grantee wishes to modify and a
written explanation supporting the request for change.
Authorteed Signature for Grantee Printed Name Date

MAO..
DEPARTMENT ACTION:
Q Approved as a Modification, subject to the following conditions, OR
D Approved as a Waiver, subject to the following conditions:
(1) All terms and conditions of the grant agreement remain in full force and effect until all performance
required by the terms of the agreement are completed. ■ ■
(2) If the period for performance has been extended, the close-out package referenced in Section 5.4B of the
Agreement must be submitted no later than 45 days following any extended parformance date.
_ (3) This request is limited to the provisions described_herein and in no way impairs the Department's ability to
seek legal recourse against the Grantee for non«compliance with either the provisions stated herein or any other
provisions of the Agreement.
D Denied (see attached)
0
Date:
Pam McDonough, Director <-> Ijyy^.
NOTE: Due to the Time Limit on Expenditure of Grant Funds imposed by the Grant Funds Recovery Act
(30 ILCS 705/1 et seq.), the extended grant term granted herein shall be deemed to take effect on
cc: <y&f5/WOd^S (Grant Manager); Keith Burklow (Accounting)
* Waivers will only be approved when the Department determines thai it is in the best interest of the State of Illinois.
+ CJ. I w«J I SOOJ

ILLINOIS FIRST PROGRAM u\
EXPENSE REPORT
4*
Grantee Name: SAM A Ufi*r

K)
Dept. ol Commerce and Community Aflairs

Address: 4 L
620 East Adams. Springfield, IL 62701
UJ
Grant No: /)/-
Prepared By:
Phone:
CO
ro
U)
Approved Budget Prior Period Expenses Paid this CO
Activities fGrantee must Yearfo-Dale Funds Previously en
(As in PART I of Year to Date Report Period
copy from Granl Expenditures Received
Grant Agreement or Expenditures (Grant Funds Only) GO
Agreement PART I or (2+3) (Grant Funds Only)
subsequent (Grant Funds Only)
subsequent modHlcalmnl (Grant Funds Only)
modification)
I
m
Grantee Certification
Dcca Certihcation
All expenditures from these project funds are for approved project costs only.
Authorized PavmentjS
Further, I certify that supporting documentation on arlwnl ^vpenditwres is on
file in our office, and that I have full signature authority to sign uu behalf of
this agency. Grant Period: 7- / FIF/Bond
Project Manager
(date)
Manager of GranÔnit
or Bureau Coordinator:
BY:
(date)
Authorized Official - Signature and Title (date) Accounting? (S
(date)
ILLINOIS FIRST PROGRAM (S
U1
EXPENSE REPORT
ro
o
Grantee Address: Dept. of Commerce and Community Affairs G>
620 East Adams. Springfield. IL 62701

Grant No: Report Period ui
FEINi
* 4
from: To:
Prepared By: £m*LJT. S/>,>-,,os}
•-»
-si
Phone: f4rf'4Jr-4&rt Dale:

Final? (Y/N) CD
ro
Approved Budget Prior Period
to
Expenses Paid this Year-toOate
(As in PART I of Year-toOate Funds Previously ©
Report Period Expenditures
•sj
Grant Agreement or Expenditures Received

Agrejfflgm PART I or (Grant Funds Only) (2+3)
subsequent (Grant Funds Only) (Grant Funds Only)
modification)
(Grant Funds Only)
All expenditures from these project funds are for approved project costs only
Further, I certify that supporting documentation on actual expenditures is on
file in our offrce, and that I have full signature authority to sign on behalf of
this agency. Grant Period:
Project^flanager:
Manager of Grant Unit
CD
ILLINOIS FIRST PROGRAM
STATUS REPORT
Grantee Name. 5o\/f ft Li-fr PmnrtrHirn Anf Report Period
Grant Number D) -I Û I 5U
Address: QQ5O ft ~> \sm\rPnCr Ai/^ ,\h<-!-< IS- Jul 1 - Sep 30 due Oct 29
-frhtli.fr D Oct 1 • D«c 31 due Jan 31
Report Prepared By: D Jan 1 • Mar 31 due Apr 28
Telephone:, Q Apr 1 • Jun 30 due Jul 31
Number of Persons Directly Benefiting or Served by the Project:, O Final Report due 30 days ahar
Proiact CompiAtad
Quarterly Status Report

(Reports are due no later than 30 days after end of each quarter)
Describe Significant Activities Undertaken with Grant Funds during the Quartan
Final Evaluation Report

(Reports are due no later than 30 days after completion of all grant funded project activities)
Describe Activities Completed or Services Delivered with Grant Funds:
FINAL EXPENDITURE CERTIFICATION (Account of Expenditure t.f Fiindsl

Amount of Federal Match Funds Expended on the Project: $ O
Amount of Local Match Funds Expended on the Project: $'
Amount ot State Funds Expended (not including this grant) on the Project: $ 'm
I hereby centfy that the information and data in this Program Status Report are true and correct to the best of the
Grantee's (and the authorized representative's) knowledge and belief.
CWl T Title
,Authorized Representative (Print/Type)
Signature (of Autpoflzed Representative!

7
'>J ftc j/s/w - f^fi/ro /Q1/^
*,
7//
ILLINOIS FIRST PROGRAM ui
EXPENSE REPORT
Dept of Commerce and Community Affairs

(S
Grantee Address:
620 East Adams. Springlield. IL 62701
Report Period
H»
to-t*¥i<& Ul
Prepared By: rJI&L. JT f*2,t+*;
Final? (Y/N) 00
10
hi
Activities (Gran\*» Expenses Paid this Year-to-Date

OJ
(As in PART I of Yearto-Date Funds Previously
copy from Cfrant Report Period Expenditures
Grant Agreement or Expenditures Received Ul
Agreement PART for (Grant Funds Only) (2+3)

CO
subsequent modification^ modification) (Grant Funds Only)
DCCA CEHTirJCATIOM
All expendrlures from these project funds are for approved project costs only
Further, I certify that supporting documentation on actual expenditures is on Authorized Payment: $
file in our office, and that I have full signature authority to sign on behalf of
Project Manager
Manager of GraotT Unit 2

1**2.
ILLINOIS FIRST PROGRAM cs
EXPENSE REPORT
to
Grantee Name: Sflfc J ///>* (S
Grantee Address:
OePt- of Commerce and Community Affairs I cs>
620 East Adams. Springfield. IL 62701 |

tn
Grant No:
Prepared By:
Phone:
Budget Line Ite^s nr Approved Budget Prior Period Expenses Paid this
Activities fGranteeimici YeartoDale Funds Previously
(As in PART I of YeartoDate Report Period Expenditures Received
copy from Grant Grant Agreement or Expenditures (Grant Funds Only) (2+3)
Aercemenl subsequent (Grant Funds Only)
(Grant Funds Only)
(Grant Funds Only)
modification)
8
Occa Certification
All expenditures from these project funds are for approved projecl costs only
file in our office, and thai I have full signature authority to sign on behalf of
this agency.

or Bureau-Geprdinator I
cs
STATUS REPORT
Report P#r'rarf
Grantee ft f rffr fh inrirH-irn \nC
Grant
Grant ^^rpi- llui/SU Q Jul 1 • Sep 30 due Oct 29
Address: QQSH u) / fiti\reno7 AvP tSfjrfrf
El Oct I-Dec 31 due Jan 31
3" Jb Q Jen i - Mar 31 diifi Apr 28
Report Prepared
D Aprl-Jun30 due Jul 3 a
Telephone:
p
Number of Persons Directly Benefiting or Served by the Project:, D Final Report due 30 day& after
Projeei Compitiad
Quarterly Status Resort

Describe Significant Activities Undertaken with Grant Funds during the Quartur
^ finai Evatuailon Reooti

(Reports are. due no later than 30 days after completion ef all grant funded project actiwttivc)
Describe Activities Completed or Services Delivered with Grant Funds;
F1MAL EXP^DITURg egftTiriCATIQW fAccaunt of Expenditure tA Funds)

Amount Df Federal Match Funds Expanded an the Project: %.
Amount of Local Match Funds Expended on the Project %
Amount of State Funds Expended (not including this grant) on the Project: $, _O
( hereby certify mat the information ano data in this Program Status Report are true ;ind correct to the best of the
Crantee's (and we authorized representative's) knowledge and belief. r-~ jl
flgQl - \ -^jBf^Zl pl^ [ ... Title Vlfces / \L_c

J^htq alLAuthorlted F^Bpreaantative (Print/Typa)
Signature of Authoriud/nepresentative
ILLINOIS FIRST PROGRAM CO
LJ)
EXPENSE REPORT
ro
Grantee Address: Oepl. of Commerce and Community Affairs o
620 East Adams. Springfield. IL 62701

Report Period in
00
2 K3
Budget Line Items nr Approved Budget CJ
Prior Period expenses Paid this lii
iiili (Ge jnusi (As in PART I of Yearlo Date Funds Previously CD
Year lo Date Report Period
copy from Granl Gran I Agreement or Expenditures Received
Expenditures (Grant Funds Only) 00
Agreement PApT f subsequent (2+3) (Grant Funds Only)
(Grant Funds Only)
subsequent
modification) (Grant Funds Only)
PccA Certification
FIF/Bond
Project Manager:
date
Manager of GranTUnit
BY: or Bureau Coordinator* ft
Aulhorized Official Signature and Title ca
Accounting:
9? Z
ILLINOIS FIRST PROGRAM in
EXPENSE REPORT
Grantee Name: to
(S
Grantee Address: Dept. of Commerce and Community Affairs C9
620 East Adams. Springfield. |<_ 62701

Report Period CJ!
Prepared By: LMuL Jr. }

Phone:
CD
J
ro
to
Activities Expenses Paid this Year lo Date
O)
(As in PART I of Year lo Date Funds Previously (S
copy from Grant Report Period Expenditures

Grant Agreement or Expenditures Received en
Agreement PART I or
(Grant Funds Only) (2+3)
CD

subsequent modification) modification)
(Grant Funds Only)
Dcca Certification
this agency. Grant Perkfl:7/ 00 -
/
(date)
o
STATUS REPORT
Grantee M»m»-5foi/» ft I g
ffTM 154
Grant Number:^f-fT-M
Address: ^50
Report Prepared JBy: M I T
Telephone:
p __^__
Number of Persons Directly Benefiting or Served by the Project:

Describe Significant Activities Undertaken with Grant Funds during the Quartnr:
l1
faTT
r~ ~> f

(Reports are due no later than 30 days after completion of all grant fundod project activities)
nWAL EXPENDITURE CERTIFICATION f Account of Expenditure of FundO

Amount of Federal Match Funds Expended on the Project: $.
Amount of Local Match Funds Expended on the Project: $.
Amount of State Funds Expended (not including this grant) on the Protect: $.
I hereby cenify that the information and data in this Program Status Report are true and correct to the best of the
Gipntee's (and the authorized representative's) knowledge and belief.
A-. .lV\t^j?igt?> llivf-^ M-taiiiA<~t? TitleV kl

Nsurie of Authorized Representative (Print/Typa)
Print/Typa) "
Date
^ of Auth driz Representative
EXPENSE REPORT
Grantee Name: fJHJNhAr/OAL /A/a Dept. of Commerce and Community Affairs

Grantee Address: ^/ A£ > 620 East Adams
FEIN:
Grant Agreement No: Report Period
Prepared By:
From: T°-
Date;
Report U
Phone;
Final?
Grantee Certification DCCA CEHIIflCATION

All expenditures Irom these project funds are for approved project
costs only. Further, I certify that supporting documentalion on actual Authorized Payment : ^ II
expenditures is on file In our office, and that I have full signature
authority to sign on behalf of this agency.
Project Manager (date)
b\ or Bureau Coordina to
nature and T tie (ddte) Accounting (dale)
nov-U-ZQOO 16:11 Fron-OXA IL FIRST
217-557-9883 7-917 P.032/065 F-732
STATUS REPORT
Grantee Name: Q
Report Per ion
Grant Number: 0/-/!
Address: 44 / 13 Jul 1 • Sep 30 aue Oc: 29
_ ■ D Octl-Dec31 due Jan 31
Report Prepared By:
D Jan 1 • Mar 31 due Apr 28
Telephone: Q"
E£ Apr 1 - Jun 30 aue Jul 31
Number of Persons Directly Benefiting or Served by the Project: n Final Report due 30 days after
Project Completed
Quarterly
(Reports are due no later
lt than
h 30 days after and of each qua.t«r)
Describe Significant Activities Undertaken with Grant Funds during the Quarter
(Reports are due no later than 30 days aft" compleJn oTal! grant funded project activities)
FINAL EXPENDITURE CFRTinr>T|rH

tindO
Amount of Federal Matcn Funds Expended on the Protect-
o
Amount of Local Match Funds Expended on the Project
Amount of State Funds Expended (not including this grant) on the Project: $"
EXPENSE REPORT
Grantee Name: Depl. of Commerce and Community Affairs

Grantee Address: 620 East Adams
FEIN:
Prepared By: To:
Date: Report H
Phone: 2 tin Final?
Grantee Certification Dcca CeiiTif icatj

All expenditures Irom these project funds are lor approved project
cosls only. Further, I certify that supporting documentation on actual Authorized Payment: S
expenditures la on file In our office, and that I have full signature
authority lo sign on behalf of Ihis agency.
BY; Mi^\3brAM &£L

Manager of Granl Un
or Bureau Coordinator
Authorized QlficlAl - Signature and Title Accounting
EXPENSE REPORT

Springlield, IL 62701
FEIN:
Grant Agreement No:
Report Period
Prepared By:
From: To:
pate;
Report ff
Phone:
Final? M/l.
Gran fee Certification

All expenditures Irom these projacl hinds are lor approved protect
costs only. Further, I certify Ihol supporting documental fon on actual Aulhorized Payment:_
expenditures is on file In our olllce, and lhat I have full signature
Project
Manager ot
Manager of GranFUnit
tiranl Unit f ) .
or Bureau Coordinator^ 'OU^K (date) /°f->)/C /
gnature^rid Tille Accounting ~ ~f"
STATUS REPORT
Grantee Name: Sa\/S &(<?(= Report P*nofl j

Grant Number:*?/-/.:
Address: 0 Jul 1 • Sep30 dueOct29 i
D 0ctl-0te31 due Jan 31 '
Report Prepared By: <LAnot ~. x?/ D Jan 1 • Mar 31 due Apr 28
Telephone: *H /4
O Apr 1 • Jun 30 Qua Jul 31
Number of Persons Directly Benefiting or Served by the Project: 0 Final Reoort due 30 days after
Protect Completed
Quarterly Status Renorf
(Reports are due no later than 30 days after and of each quarter)
._ . Final gvajj|fltjon Bepnrt

(Reports are due no later titan 30 days after compleJof"^ grant funded project activities)
. E1NAL EXPENPITUBF cnmn^TIOM a

rfJl
Amount <* Federal Matcn Funds ExpendedTn T
SS
SmS
Amount 2
of Si ? Expended
State pFunds
8t? cUndS &piBd-d on "» ***
(not including this grant) on the Project:
Signature of Date /O-/4-0/
c-e. /of3
f SAVEAUFE
FOUNDATION
October 22. 2001
Executive Board Susan Boggs. Gram Specialist

Carol J. Spizzirri, President/Founder Illinois FIRST Grant Unit
Hon. Sam Amirante, Vice President IL Dept. of Commerce & Community Affairs
Daniel Caravello, Treasurer 620 E. Adams St.
Scon Anderson Springfield. IL 62701
StanZydlo.M.D.
National Board of Directors
Hon. Martin A. Sandoval, Secretary Re: Grant No. 01-120390

Carlos M. Azcotia Grant No. 01-124154
Scon Betzelos, M.D.
Deloris M. Bumam
Robert Conroy Dear Susan.
Michael Lavelle, Esq.
Wayne Roberts, FF/EMT-P

Lteal Counsel
Enclosed are the status and expense reports of the Save A Life Foundation for
Robert Motta, Esq.
the reporting period July 1. 2001 - September 30. 2001.
Medical Dirfclor
Stanley Zydlo. M.D. Should you have any questions or need further information, please do not
Medical Advisor* hesitate to call or write our office.
Peter Safar, M.D.
Henry Heimlich, M.D. Thank you for your assistance in overseeing our reports.
Nicholas Bircher. M.D.
Mark Mitchell, DO. Sincerely.
Emest A. Pretto, Jr., M.D.
Paula Willoughby, D.O.
Brian Churchill, EMT-P
Illinois Stite Chairman Linda Post
Mark Mitchell. D.O. Finance Manager
Program Development
Hon. Irv Bock

Bill Nolan
Encl. 6 pages
Ralph DeBanolo
National Advlinrv Board
Hon. Rita Mullins

Garry B. Criddle Capl USC (Ret.)
Ellen Schmidt
Chris Hanna
Jeffrey A. Schwartz, MD FACEP

Stephanie Bryn, MPH Save A Life Foundation
Marilyn J. Bull MD.
Judy Robinson, PHD RN 9950 W Lawrence Suite 300 Schiller Park, Illinois 60176
Deborah Ann Mulligan-Smith M.D. (847)928-9683 Fax (847) 928-9684 www.salf.org
Mary Jean Erschen R.N., B.S.N.
EXPENSE REPORT
Grantee Name: Stirfe A /./PB /A/a. Pepl. of Commerce and Community Affairs
Granlee Address: pf-fft ///, 620 East Adams
FBH:
Prepared By; —from; To:
Data: Report if I
Phone: Final?
Ceriificaiioh Dcca Cehiihcation

All expenditures Irom these project liinds ore lor approved project
costs only. Further, I certify (hot supporting documentation on actual
expenditures h on fllo In our olllco, and that I huvo full ll
aiilhorily to sign on behalf ol Ihls uyoncy.
idale^
BY:
Manager of Granl I Jnil
or Bureau Coordlnalor
.Authorized Olfjcjaf Signaltite and Title (dale) Accounting **~"
EXPENSE REPORT
Grantee Name: SA\/£ A //?£ Depl. of Commerce and Communily Aflairs

Grantee Address: llL 620 East Adams
SpringHeld, IL 62701
FEIN:
Grant Agreement No:
Report Period
Prepared By:
From: To:
pate:
Report it
Phone:
Final?
Grantee Certification DCCA CE«1 IflCATION

All expenditures Irom these projecl lunds are lor approved project
cosls only. Further, I certify that supporting documentation on actual
expenditures is on file In our oflice, and that 1 have full signature
.authority to sign on behalf of this agency.
Projoct Manager (date) /'S/'OZ.
Manager of Grant Onit
Authorized Official ♦ Signature and Title Accoimllng
STATUS REPORT
Grantee Name: Saws A

Grant Number 0/—
Address:
Report Prepare? Sy: dAao/ S. vyi r
NumDer of Psrsons Directly Benefiting or Served by the Project:

Quarterly Status Rennrt
(Repom
project activities)
Describe Acuities Comoleted or Services Delivered with Grant Funds:
Funos Expend*
Amount of Loai Match Funds Expended on SePn
Amount „ State FunQS Expenae. (noI inc^g^nt) on m,
i nerecy csrtify that tha information and data in this
Grantee's (anottie authonad ^^ are true ano csrrec: to tne oest of trie
i"a&. Title rfel /fry}'A/.,\sri>
Signature of Autnonzea Representative Date •

EXPENSE REPORT -
Granlee Name: S/itfe A l/P£ Oepl. of Commerce and Community Aflairs

Granlee Address: qjê ///, 620 East Adams
Springfield. IL 62701
FEIN:
Prepared By: ;
Date:
Phone: 1-I-ejL 3
Certification
All expenditures Irom these project Umds are lor approved project
costs only. Further, I certify that supporting documentation on actual
expenditures Is on file In our office, and that I have full signature
authority to sign on behall ol this agency.

byN^
EXPENSE REPORT -
Grantee Name: Depl. of Commerce and Community Adalrs

Granlee Address: 620 East Adams
Spi jnglield, IL 62701
FEIN:
Grant Agreement No: Report PeiiocJ
Prepared By: from; To:
Pale:
Report n
Phone:
Hnal?
Grantee Certification DccA CennncATion

All expenditures Irom these project (unds are lor approved project
costs only. Further, I certify Ihat supporting documentation on actual
expenditures Is on Ilia In our olfico, ami that I liavu full si^naluru
auJhoM to sign on behalf ol Ihls agency.
Project Manager
Manager of Grartt Untl
or Bureau Oooidinalor
_Accounljng
flov-u-ZQOO 16:11 Fra-OCQL IL FIRST
217-S57-3SB3 "-31" P.DSZ/OEs --'II
ILLINOIS RRST PROGRAM

STATUS REPORT
Grantee Name:
Report Per ion
Grant NumDer
Address: 0
U Jul 1 • See 30 aue Oc: 29
D 0« 1 • Dec 31 aue Jan 31
Report Prepared By; Hajig/
Telephone: £11- '
J& Jan 1 ■ Mar 31 aue Aor 2S
D Apr 1 - Jun 30 aue Jul 31
Number of arsons Directly- Bene^ng or Served by the Project? Final Reoort aue 30 aays after
Proiect Compiecea
Quarterly St^tTPf p-r-Tt
Describe Significant Achvit.es Undertaken with Grant Funds during the Quarter
-
final
(Reports are due no later than 30fcys afte/coWietionVall grant funded project activities)
Describe Acrivities Completed or Services Delivered with Grant Funds:
Amount of Localal Match Funds Expended on tie ProieS

ProieST
Amount of State Funds Exoencled
Eld (not ( inoudln,
i tSTSntt
STS on the
Sigriature oi Authori;
I of3
Executive Board
Mav 31.2002
Carol J. Spizzirri. President/Founder
Hon. Sam Amiranlc. Vice President
Daniel Caravello. Treasurer

Susan Boggs. Grant Specialist
Hon. Manin A. Sandoval. Secretary
Directors
Illinois FIRST Grant Unit
Carlos M Azcolia
1L Dept of Commerce & Community Affairs
Stanley Zydlo. M.D.
620 E. Adams St.
Springfield. IL 62701
Scott Dctzclos. M.D.
Dcloris M. Bumam
Michael Lavclle. lisq.

Re: Grant No. 01-120390
Robert Conroy
Grant No. 01-124154
Wayne Roberts. FF/liMT-P
Legal Counsel
Robert Motta. Esq.

Dear Susan.
Medical Director
Stanley Zydlo. M.D
Medical Advisors
Enclosed are the Amended Status and Expense Reports of the Save A Life
Peter Salar. M.D.
Foundation for the reporting period Jan. 1. 2002 to March 31. 2002. The
Henry Hcimlich. M.D.
amended forms reflect the amount for Instructor Fees overstated in
Stanlej Zydlo. M.D.
comparison to the budgeted line item amount.
Mark Mitchell. DO Pending approval of the modification request to allow the line item
limest A Prello. Jr.. M.D. "Unemployment Insurance" to include payroll taxes, our final report will
Paula Willoughby. DO reflect an expense for the balance of that line item.
Brian Churchill. KMT-P
Illinois Slate Chairman Please contact me with your comments or for further information that may
be needed. Thank you again for your assistance.
Mark Mitchell. DO
Slalc Development
Sincerely.
Hon. In Bock
yO
Ralph DeBartolo
National Advisory Board
Hon. Rita Mull ins

Linda Post
Garry 13 Criddle Capt USC (Ret.)
Finance Director
Ellen Schmidt
Dill Nolan
Enc. 6 pages
Chris I lanna
Jeltrcs A Schwaru. MD IACEP
Stephanie Uryn. MPH
Marilyn J. Bull M.D. Save A Life Foundation

Judy Robinson. PUD RN
Deborah Ann Mulligan-Smith M.D. 9950 West Lawrence Avenue. Suite #300. Schiller Park. Illinois 60176
Man Jean lirschen R.N.. H.S.N
Phone: (847) 928-9683 (888) 892-0606 • Fax (847) 928-9684 • e-mail: saliTcids^salf.org -www.salf.org
GEORGE H. RYAN
DIRECTOR
August 08, 2002
Ms. Carol Spizzirri. Pres/Founder

C/0 Save A Life Foundation
9950 LAWRENCE AVE STE 300
Re: Subgrant No. 01-124154 Close-Out Package

Dear Ms. Spizzirri:
The Department is in receipt of the close-out package

connectian ui +K +Ha *»HnwA ——^ . . fuwayc
three years following expiration of the term
s?
three-year records retention period we determine that"
norr close-out packase

With ^^ P-visions of
Thank you for your cooperation in this matter.

Sincerely,
Christ1 DeGroot
Assistant Manager
Accounting Office
CC: Patty Hughes

Close-Out File
TOO CaOMI*-CM7
-itn tsd ioai»M'eu«

ftov-14-2000 16=12 Froa-DCCA IL FIRST 217-557-9883 T-917 P 034/065 F-732

George H. Ryan
Governor ' pa"> MeDonough
Director
November 14, 2000
Ms. Carol Spizzirri

President/Founder
9950 W. Lawrence Ave., Suite 300
Dear Ms. Spizzirri:
Enclosed please find Grant Agreement Number 01-124154 between your organization
('Grantee") and the Illinois Department of Commerce and Community Affairs
("Department"). Please review the Agreement carefully to ensure trut the Grantee's
rights and responsibilities are clearly understood. You are encouraged to have the
Agreement reviewed by an attorney. In particular, please note the following:
Beginning Date (Notice of Grant Award). Costs incurred prior to the specified
beginning date are not eligible for reimbursement, unless such costs, have been
identified in the Project Budget and approved by the Department.
End Date (Notice of Grant Award). The Project must be completed by the stated
end date. Modifications for scope of work changes or date extensions must be approved
in writing by the Department and processed prior to the stated end date.
Part II ■ Special Conditions. Part II requires specific acknowledgment by and

acceptance of the Grantee of all obligations set forth therein. The Grantee is expected to
be thoroughly familiar with the provisions of Part II, including requirements regarding
the submittal of reports, authenticating documents, etc.
If the terms of the Agreement are acceptable, please complete the fcllowing steps in
order to properly execute the Agreement:
• verify the Grantee"s correct federal taxpayer identification number (FEIN) and
correct legal/business status in the appropriate blanks on pajjes 1-2;
• have an authorized official of the Grantee execute page 2 of the Notice of Grant
Award and the acknowledgment set forth in Part II;
Internet Address htip://ww*.comnierce.iuih?,il.i»
■sassa ..cKgEsr,. ■ssssssar

1IVHJ-75OO )l2/tl4?i?»
«*tdd «»,«,, ,„ „„„«„.„„ ,M/419^7 ,„ nntdZwS?*™** ,„
Pruned M Recycled wd Rac>daUo Ptjw
Nqv-U-2000 16M2 Fro-DCCA IL FIRST 217-557-8883 T-817 P035/065 F-732
• make any necessary corrections to the Grantee's address; fill in the name, phone
number, and address (if different from the Grantee's address) for the
administrator/project manager; and
• please review Section 6.6 carefully and mark the statement with an "X" as it
relates to the Grantee.
• if "Grantee Disclosures" are required by the Department, the disclosures must

be completed, signed by an authorized official of the Grantee organization and
returned with the executed Grant Agreement.
The Grantee's ability to incur costs against the Grant as of the beginning date set forth
in the Notice of Grant Award is contingent upon the Grantee's acceptance of the terms
and conditions as set forth in the attached Agreement. The Department may elect not
to execute the Agreement if any of the terms are changed without the Department's
prior approval, and the Grantee will be responsible for any costs already incurred.
The Department may also elect not to execute the Grant Agreement if it determines that
it is not in the best interest of the State of Illinois to do so. Written notification of such a
determination and the basis therefor will be provided to the address.ee of this letter in
such event.
IMPORTANT INSTRUCTIONS: Please return the ENTIRE SIGNED ORIGINAL document

to the individual indicated in Exhibit 2 of the Grant Agreement. Please direct any
questions concerning the Agreement to the individual identified in Exhibit 2.
ADDITIONALLY, the forms to be utilized in preparing reports required by Part II of the

Agreement are also provided In this packet. Reports will not be accepted unless these
forms are used.
You will be provided with a fully executed copy of the Agreement after it has been signed
by Director McDonough.
Sinoe^ly,
y
Susan Boggs
Illinois FIRST Grant Manager
Enclosures
GEORGE H. RYAN ■ PAM MrnnNnnrH

GOVERNOR rAn nCDONOUGH
DIRECTOR
June 12, 2002
Ms. Carol Spizzirri, Pres/Founder

Dear Ms. Spizzirri:
The Illinois Department of Commerce and Community Affairs Is currently

in the process of closing out the above referenced grant. To facilitate
this process we are enclosing a close-out package and applicable
Instructions. Please complete the information requested and return
by August 14, 2002 to:
Department of Commerce and Community Affairs

Accounting Office
620 E. Adams Street - 2nd Floor
Springfield, II1inois 62701
If your grant agreement, under Part II, Section 2.5, requires a final
expense and status report; the submittal of the enclosed close-out
package will serve to satisfy the reporting requirements, once your
package is approved by the Department.
If your grant agreement, under Part II, Section 2.5, requires quarterly
status and/or expense reports, you may elect not to submit the reports
for the last period of your grant agreement provided you have already
received the full amount of the grant funds as stated in your grant
agreementÎn other words, if you have not received all of your grant
funds, you must submit an expense report to request the remaining funds
prior to the completion and submittal of the enclosed close-out package.
You must continue to meet the requirements of proper cash management for
the rema n1ng term of your grant by limiting cash to an amount necessary
to meet immediate cash needs. Excess cash should be returned to the
Department immediately. Upon final submission of your close-out anv
remaining unexpended cash should be refunded as defined in the enclosed
procedures.
Should you have questions about the close-out package or Instructions

please contact Dave Nelson at (217) 524-0255.
Sincerely,
Christ 1 OeGroot
Assistant Manager
Accounting Office
CC: Patty Hughes '

Close-out File
^k-*&&* •'■ -- - AJtaA« ■■■•■•I*. llHtt9fl# VtfVVV
i Tcotsann-teu 'Axiiinu-trn toot

Confirmation Report — Memory Send
Time : May-21-2002 01:46pm

Tel line : 217-557-9883
Name : DCCA IL FIRST
Job number : 347
Date : May-21 01:42pm
To : 918479289E84
Document pages : 884
Start tine : May-21 01:44pm
End time : May-21 01:46pm
Pages sent : 884
Status : OK
Job number : 347 *** SEND SUCCESSFUL ***
Illinois
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DATS!:
\
■TO: * S*gt
TELEFAX NUMBER:
From: Susan Boggs. Grant Manager

Fax number: 217-557-9883
Phone numbar:217-7B2-6346
E-mail address: sboggs@commorca.stats.ll.us
NUMBER OR PAGES TO FOLLOW:

COMMENTS
>*• •■*• • TOO A«iv; •«»;

George H. Ryan
Governor Patn McDonough
Director
April 12.2002
Ms. Carol Spizzirri

President/Founder
Save A Life Foundation. Inc.
9950 W. Lawrence Ave.. Suite 300
Dear Ms. Spizzirri:
Please be aware that your Illinois FIRST grant number 01 -124154 is due to expire on June 30 2002 The
Illinois Department of Commerce and Community Affairs, which administers your grant, would like to alert
you to your remaining responsibilities regarding this grant.
• If you will be unable to complete your project before June 30. 2002. the Department will consider a
request for an end date extension. The form you will need to modify your Grant Agreement is
attached. If an extension is necessary, please submit it immediately.
ifrr?,h ^^ SS6rnt gran r '""^ different|y than vour 8rant agreement authorized, you will need to use the
<zttrf c::™ t * :^!* a^mai s™ modification bef°- ^ pj
■**««be dosed.
Z£7*6£7 ° PerCent V3rianCe in 3ny bud*et line item wkhou't a modification, if
you have added any new l.ne .terns or activities, eliminated any line items or activities, or exceeded the
10 percent vanance in any line, you must file a request for a modification.) Please note that
modifications will not be granted if the expenditures are inconsistent with the authorizing legislation and
legislative mtent. Once again, if a modification is necessary, please submit it immediately.
• Some Illinois FIRST projects are required to submit Quarterly Expense Reports and/or Status Reports
Please contmue to submit your reports as instructed by your grant manager, until your grant ends If'
any reports are delinquent, you must submit them before your grant will be allowed to dose.
• If you do not take action to extend your grant, you can expect to receive your Close-out Package in
June; you must complete the package and submit it to the department by August 14. 2002.
If you have any questions regarding the contents of this package, or if you feel you have received this letter
m error, please call your Illinois FIRST program manager. Susan Boggs, at 217-782-5346.
Sincerely,
Ron Pufundt, Manage/ '

Enclosure
Internet Address hup •'www.comint.Tce.5late.il.iis
...rni>«nO4,<M>6»7 F« :,7 78< ;61S .TDO :177850:M (1> m«W.,,>5 .TDDR.hy800/5J6-0S44

WimcJ i<n RttvckJ and Rctychh* pjpn
Confirmation Report - Memory Send
Time : Apr-04-20D2 10:34am

Tel line : 217-557-9883
Name : DCCA II FIRST
Job number
Date
To
Document pases
Start time
End time
Pages sent
Status
Job number : 714

*** SEND SUCCESSFUL ***
Illinois
Department of Commerce and Community
TELEFAX COVER SHEI
£°.: £*j?: 5?arolJ. Spizzlrri

Carol J. Spizzlrri
TELEFAX NUMBER: 647-928-9684
: Eboga8@commaro
Of your
n or •
Italy In
7?Tu,B^hJZ!*2a wi" b" sP»"t by O6/3O/O2 In «=e«, ^ nocaoa.ry. I will contact you.
your
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EXPENSE REPORT
Dept. of Commerce and Community Affairs

620 East Adamsr Springfield, IL 62701
Report Period ~ ~
Prepared By:
Phone:
Pudge| Line Items or Approved Budget Prior Period Expenses Paid this
Activities (Grantee must (As in PART I of Year to Date
Year to Date Funds Previously
copy froriLGrajii Report Period Expenditures
(Grant Funds Only)
Agreemen! PART Lor subsequent (Grant Funds Only)
(2+3) (Grant Funds Only)
JMbsequent modification) modification) (Grant Funds Only)
Further, I cerfly that supporting documentation on actual expenditures is on Authorized Payment: $
Ihis'a °eUnrc°Mlce' and that » have '"« ^nature authority to sign on behalf of
HEBE Manager of Grant Unit

(date)
BY: or Bureau Coordinator:

Authorized Official Sipn •lm.* ..n-» Tin.
(date)
EXPENSE REPORT
Grantee Name:
Grantee Address: Dept. of Commerce and Community Affairs
620 East Adams, jprinefield, IL 62701
Grant No:
Prepared By:
. Phone:
Final? (Y/N)
Budget Lint (terns or Approved Budget ?Vior Period Expenses Paid this Year to Date
Activities (Grantee must (As in PART I of Funds Previously
Year to Date Report Period
copy from.Grapt Grant Agreement or Expenditures Received
Expenditures (Grant Funds Only)
Agreemeji! PART I or (2+3) (Grant Funds Only)
subsequent (Grant Funds Only)
subsequent modification! it Funds Only)
modification)
Kirlher, I certify that supporting documentation on actual expenditures is on
He in our office, and that I have full signature authority to sign on behalf of
this agency.
BY:
... Authorized Official • Signaturp anfrntu idate)
EXPENSE REPORT
Grantee Name
Grantee Address Uept. of Commerce and Community Affairs
620 East Adamsr Springfield. IL 62701
Grant No: Report Period
Prepared From: To:
Phone:
Final? (Y/N)
Items or Approved Budget Prior Period

Activities (Graptee must (As in PART J of
Expenses Paid this Year to Date Funds Previously
Year to Date Report Period
AfireemenLPARTlor subsequent (Grant Funds Only)
(2+3) (Grant Funds Only)
■lijfa§g<|uen| modification) modification) (Grant Funds Only)
SO M
2I0_
M.
30
1£L
MO_
no
—£Z16l
<Ji>00
Grantee Certification iV/1,
All expenditures from these projeci lunds are lor approved projeci costs onlv
Furlher. I cerl.ly that supporting documentation on ac.u,- 1 'Td ,ures is on Authorized Payment: $
l^'^ ' and tha' ' h3Ve IU" it hri(3i £ Grant Period:
FIF/Bond
Project Manager:
(date]
- Authorized Official (date)
(date) Accounting:
EXPENSE REPORT
Address: Dept. of Commerce and Community Affairs I

620 East Adams, Springfield, IL 62701
No: Report Period
From: To:
Prepared By:
Phone:
Final? (Y/N) \jjp
1
Budget Ling Items Pf Approved Budget Prior Period
Activities (Grantee must Expenses Paid this Year to Date
(As in PART I of Year to Date Funds Previously
Report Period Expenditures
sgpy.(rsm.6rant Grant Agreement or Expenditures Received
(Grant Funds Only) (2+3)
Agreement PART! pr subsequent (Grant Funds Only) (Grant Funds Only)
_fjjbsequent modification) modification) (Grant Funds Only)
3B5
51$
450
150
Dcca Certification
All exuenrlilures from these project funds are for approved project costs only
t-urthei. | certify thai supporting documentation on actual expenditures is on Authorized Payment: $
He in our office, and that I have full signature authority to sign on behalf of
FIF/Bond
Project Manager:
(date)
BY: or Bureau Coordinator:
Authorized Official Signature and Title (date)
EXPENSE REPORT
Grantee Name:
Grantee Address: Dept. of Commerce and Community Affairs
620 East Adams^prjngfield. IL 62701
Report Period ~
Final? (Y/N)
Budge! Line Herns or Approved Budget Prior Period Expenses Paid this
Activities (Grantee must (As in PART I of Year to Date Funds Previously
Year to Date
copy. fromGr^ni Grant Agreement or
Report Period Expenditures Received
Agreement p^Rl"! or. subsequent (2+3) (Grant Funds Only)
(Grant Funds Only)
fMbsequentmodUtcation^ modification) (Grant Funds Only)
&fiU
All expenditures from these project funds are for

Further, I certify that supporting documentation

SAVE A LIFE
FOUNDATION Thursday, February 01, 2001
Susan Boggs
DCCA Department of Commerce and Community Affairs
Board of Directors:
Carol SpiZZini. President/Founder
Hon.Sam Amirante. Vice President
Carlos M. Azcoitia Dear Susan:
Carlos Cortes. Treasurer
Hon. Martin Sandoval. Secretary Our financial report for our $600,000 grant was submitted this
Scott Anderson past Fall and should have been received by yourself. Our
Scott Betzelos. M.D.
audit will be completed early April and a copy will be send to
Deloris M. Burnam
you immediately. If you have any questions or requests from
Robert Conroy
me, please don't hesitate to call.
Michael Lavelle. Esq.
Margarette Lawless
Wayne Wiberg
Thank you again for your help.
Ken Wiesner
Stan Zydlo. M.D.
Leoal Counsel: Since rely

Robert Motta ESQ (
Medical Director-
Stanley Zydlo. M.D.
Carol J. Spizzirri
Assoc. Medical Director President/Founder
Scott Beuelos. M.D.
Medical Adivisors:
Peter Safar, M.D.
Henry Heimlich. M.D.
Mark Mitchell, M.D.
Ernesto A. Pretto, Jr. M.D.
Paula Willoughby. M.D.
Program Developmpnt-
la- Bock. Director
IL Central Branch:
St. Johns Hospital, Springfield
Jan Kelley, RN, Facilitator

9950 West Lawrence Ave . Suite *300. Schiller Park IL 60176
Phone (S4/I 928-9683 (SSS) 392-0606 • Fax 1847)928-9684 • e-mail: salffcdsSSALF.org • uuw.SALF.org
4825 N. Scott St.. Suite 74-A. Schiller Park. IL 60176
Phone: (847) 928-9683 Fax: (847) 928-9684 e-mail: SAUFE@aol.com Web: wvw.SALF.org
Monday, August 28,2000
Susan Boggs
DCCA Department of Commerce and Community Affairs
Dear Susan:
Attached are letters that we that just sent to Senator Walter Dudycz and Representative Ralph Capparelli
regarding when the money for the Blue Angels program would be made available. As you can see bv the
letter, we are rather complimentary of your efforts. y
Thanks again for all your help.
Sincerely,
Mitchell Newton-Matza
"Training of life supporting first aid.'

Monday, August 28, 2000
Ralph C. Capparelli
Illinois State Representative (D)
7452 North Harlem Ave.
Chicago, IL 60631
Dear Representative Capparelli:
In a recent conversation with Susan Boggs of the Department of Commerce and Community Affairs we
were informed that the grant money for the Blue Angels would be delayed by another month or two ' We
submitted our survey forms in July and August, and today Ms. Boggs, who has been very helpful '
throughout let us know that the paperwork was processed by her department, then sent to the governor's
office but there was no guarantee as to when any grant agreements or releases would be available and
that the money would not be coming shortly. Is there anything we can do to expedite this process?'
Thank you again for all your help and support with our mission.
Sincerely,
Mitchell Newton-Matza
Project and Research Director
cc: Sen. Dudycz, S. Boggs
ACT/RepresentativeCapparelli0826O0
Date: Saturday, July 01,2000

Community Affairs
Susan Boggs
Phone:
Fax: 217-557-9883

Carol J. Spizzirri
Phone: 847-928-9683
Fax: 847-928-9684
Pages: 2
Subject: Blue Angels:
Please advise: State Rep. Capparelli told me that he

sponsored an additional $25,000 is that correct? Will I
be receiving additional forms? Thanking you in
advance for you response.
Carol J. Spizzirri
Illinois Denartment of Commerce and Community Affairs
George H. Ryan
Governor Pim McDonough
Dirtctor
TO: Ms. Carol Spizzirri, President

FROM: Susan Boggs, Illinois First Grant Management Unit
DATE: June 29,2000
RE: FY 2001 Grant Appropriation
Project No.: SD0183

Appropriation Section No.: HB4437 75 1260
Amount: $25,000
Purpose: various costs for "Blue Angels" life saving program
Legislative Sponsor: Senator Dudycz
Please be advised that the Department of Commerce and Community Affairs has been
given the responsibility of administering the above mentioned grant. In order for us to begin the
process, you are being asked to complete the enclosed survey form. The information supplied
on this form will allow us to develop a formal grant agreement (legal document).
Once the grant agreement process is completed and all documents are in order, we will
begin the payment process. Be aware that there is no set timeline for grant recipients to
receive their funds; however, processing time is largely determined by the accuracy of
the information contained in the survey.
Please note that the first page of the survey provides some important points to keep in
mind while filling out the survey. If you have questions, feel free to contact me at 217-782-5346.

Susan Boggs
Or fax the survey to: 217/557-9883
Internet Address http://wwwxommerce.staie.i1.us

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T°: Susan Boggs
(217)557-9883
From: Save A Life Foundation Date: 7/12/2000
Blue Angels Job Descriptions
CC:
D Uigent DForReview D Please Comment D Please Repty D Please Recycle
enpoon for our Blue Angels program was mistakenly left out of
-vey mailing you should have received today. A hard copy of
on is in the mail. Please contact me at (847) 92S-9683 if vou
need anything else. ^
Newton-Matza
A Life Foundation
.•:»•!•:»'"■•'••'"■>'
To: Susan Boggs
(217) SS7-S883
-
From: Save A Life Foundation 7/24/2000
DForRevtow
Comma* QPteaseRepy Q Pteaae Racycfe
be the extra information you needed. Please call me at (847) 928-
if you should require anything else.
Mitchell Newton-Matra
« f $ l
To: Susan Boggs Fax: (217)557-9883
From: Save A Life Foundation Date; 7/31/2000
Rk Additional Materials for Funding Pages: 2
CC: [Click here and type name]
D Urgent □ For Review Q Ptease Comment DPIeneRepty □ Please Recycle
d be what you need. Please call me at (847) 928-9683 if you have
other questions.
P
ell Newton-Matza
George H R\an
Governor
May 01, 2001
Ms. Carol Spizzirri

President/Founder
Dear Ms. Spizzirri:
Your executed grant agreement for Illinois FIRST grant 01-124154 requires that vour
orgamza ,on subm.t quarterly reports as a condition of receiv.ng the gram Our
.nd.cate that the following quarterly rePort(s) for your grant has/have^? beer
Reporting Period
01/01/2001-03/31/7001
°rd.r* ensure compliance with the grant agreement, please mail the quarterly
eport(s) to my attention within 15 business days of the date of this letter Reporting
forms and instructions are attached for your use. If you have any questions regard"nR
your grant, please call me at 217-782-5346 M regarding
Sincerely
jsan tfbggs
Grants Manager
Illinois FIRST Unit
Attachments
cc: File
Inicmei Address hup //u->\as.commerce stale il us

o R ThoiDpton Center
'?< Wen Adann Slfcel »rd Hoar
- ■ tt t>: Rmdolph Sirtei Suilc i-lfin jtivvttu Mam Sune Ilk
Spnnytield ltnnoi« t>;?i*-S. I
M.mmi Illinois o?1)***
fax :i*"S>-M<-«!UD >'iv >*.f-«*

-j: .too
ci on Krcitlcd and Rrc>;ijh^c I'iptf

II ISJV Illinois Department of Commerce and Community Affairs
George H. Ryan Pan, McDonough

Governor . Doctor
May 17, 2000
Ms. Carol J. Spizzirri

President & Founder
4825 North Scott Street
Suite 74-A
RE: Add-On Grant #99-12094/$600,000
Dear Ms. Spizzirri:
This letter summarizes the results of the monitoring visit conducted on May 10, 2000. The purpose of
this visit was to provide an independent monitoring of your fiscal year 1999 General Revenue Fund (GRF)
grant to ensure compliance with the requirements of the grant agreement and to review your fiscal
management.
As a result of the monitoring visit and by reviewing the report submitted by the monitor, the Department
•has found, that Save A Life Foundation is, to date, in compliance with the provisions of your GRF Grant
and no further action on your part is deemed necessary at this time.
Thank you for your cooperation during the monitoring visit. If you should have any questions Dlease
contact our office at (312) 814-3166. '
Sincerely,
Robert L. Hearn, Manager

Grant Monitoring Section
Division of Audits
cc: Dan Kahle, Acting Manager, Division of Audits

Gail Hedges, Program Manager
Susan E. Nicol, Grant Monitor
Files
Internet Address http://www.commcrce.statc.il.us

) East Admit Sitki limes
Primed on Recycled and Recyclable Pipn

DCCA-C-0
ILLINOIS DEPARTMENT OF COMMERCE AND COMMUNITY AFFXiRX
OFFICE OF ACCOUNTING " . ' •■>
SUBMITTAL OF CLOSE-OUT DOCUMENTS
T 01-124154Nprant Period: O7/O1/2OOO thru 06/30/2002

. Name1!—Sa5BUCfc+ttrToundat i on
Requ i red Document

Identification of Document Enclosed
iZi
!=!
iZi
\JL\
SSSBSSSSSSSSBSSSSSS;;
Grant Close-Out Certification Statement
To the best of my knowledge and belief, the Financial
I certify that I have full signature authority to sign the attached

close-out report on behalf of this agency. 9 attached
Authorized
Date
Title
(Directions on Reverse Side)

ILLINOIS DEPARTMENT OF COMMERCE AND COMMUNITY
OFFICE OF ACCOUNTING
RECONCILIATION STATEMENT
Grant No.: O1-1241S4 Grant Period: 07/01/2000 thru OB/30/2002

CASH BALANCE
1. Beginning Cash on Hand
-0-
2. Total Amount of Grant money received
3. Total Cash Available (line 1 + 2)
4. Less: Total Costs (Per Expenditure Summary Total

Form DCCA-C-0-2)
5. Balance of Cash On Hand (line 3 - 4)
-4-
- , . , GRANT BALANCE
6. Total Grant Amount (Including all
modifications)
7. Total Grant Amount Received from D.C.C.A.
8. Unexpended Amount of Grant (line 6 - 7)
«eporx of Grant Principal

9. Grant Prince
a. Total Grant Amount
(Including all Modifications) a) ♦ JS.dffl. 00
b. Total Interest Earned b) + -Q-
c. Total Grant Amount plus Interest (a + b) * (C)
Less: Costs Incurred under Grant

d. Total Grant Amount Expended d) ♦ Jj.fltfQ. &0
e. Total Interest Expended e) ♦ -^-
(If grant agreement allows)
f. Total Costs Incurred (d + e) = (f)
Unexpended Funds to be Returned to per a

g. Balance of Grant Amount g) + -Q —
h. Balance of Interest Earned h) + -0-
i. Total Unexpended Grant Amount

and Interest
(9 + h) = (i)

DEPARTMENT OF COMMERCE AND COMMUNITY AFFAIR^™ 2
STANDARD EXPENDITURE SLJMMAPV
GRANTEE NAME: Save A Life Foundation
GRANT NO.: 01-124154 REPORT PERIOD: FROM 07/01/2000 THRU 06/30/2002
PHONE:
PREPARED BY:
ILLINOIS DEPARTMENT OF COMMERCE AND COMMUNITY AFFAIRS°CCA~C~°*3
Grantee Release
Grant No.: 01-124154 Grant Period: 07/01/2000 thru 06/30/2002

Pursuant to the terms of Grant No. 01-124154 and in

consideration of the sum of M. 004* O&
. . . . (Expenditure Summary Total-FORM OCCA-C-0-2)
which has been or is to be paid under the grant to:

hereinafter called the Grantee or to it's assignees, if any the

c™n?;«U?« Pay«nt of the «'d sum the Department of Commerce and
Community Affairs hereinafter called the Grantor, does remiss release
lu ? ab?nf?«° G£??tO:; HS °Vicers- a9ents and employees of aid from
aMsinffromihe
ifi sS!d9gran?S>except
S!9?St "« d~n* Wha<—
Wh< -"- or
1. Specified claims in stated amounts or in estimated
?asi jars Y!2,«{srs snsurajsTts

arising out of the performance of the said grant
which are not
known to the Grantee on the date of execution of 'this re?eL2 In* ««
wîch the Grantee gives notice in writing to the Grantor "thin ?he
period immediately following acknowledgement of sail exJenseS
It is the sole responsibility of the Grantee to timely

**
(DIRECTIONS ON REVERSE SIDE)

ILLINOIS DEPARTMENT OF COMMERCE AND COMMUNITY AFFAIRS^ DCCA'C-°-4
REFUND CHECK BREAKOUT

DOLLAR AMOUNT
1. Balance of DCCA Grant Amount

(Must equal Line No. 9g from the
Reconciliation Statement - Form
DCCA-C-0-1)
2. Unexpended Interest or Interest

earned on funds received.
Must refer to your grant agreement $ "0-
to determine interest requirements. :
(Must equal line 9h as stated in the
DCCA-C-O-1).
3. Total Amount of Refund Check due DCCA $ r^*~

(Line 1 plus line 2. Must equal line "^
91 as stated in the Reconci laition -r
Statement - Form DCCA-C-0-1)

FORM DCCA-C-O-5

GRANTEE'S ASSIGNMENT OF REFUNDS ANO CREDITS

Pursuant to the terms of Grant Agreement No. 01-124154

and in consideration of the reimbursement of costs and payment of fee
as provided in the said Grant and any assignment thereunder

hereinafter called the Grantee does hereby:
1. Assign, transfer, set over and release to the Department of

rSTSES8 n2d Cor;n1ty *"•"■« all right, title and interest to all
refunds and credits or other amounts (Including any interest
thereon) due or which may become due, and forwlrd promptW to the
?oP?h2^2« SI ^r6:^ and Coi™"*y *****rS check? (mSdepaJVl
to the Department of Commerce and Community Affairs) for anv
proceeds so collected. The reasonable costs of any such act
snSrsS
to
any amounts otherwise payable to the Department of Commerce

Co and
Community Affairs under the terms hereof. commerce and
2. Agree to cooperate fully with the Department of Commerce and
^HSSSjais therewith; and to permit the Department of CommSrce

and Community Affairs to represent it in any hearing tMa7 tr
other proceeding arising out of such claim or suit
ILLINOIS FIRST PROGRAM AFFAIRS
FINAL STATUS REPORT

FEIN:
™ »-■,
The Grantee is a nonprofit corporation for the public benefit and provides
instruction to the community in basic hands-on life supporting first aid
including cardiopulmonary resuscitation. Through this grant for the Blue
Angels Program, the Grantee was able to promote the moral ethical and
compassionate duty to act in another's behalf by teaching life saving first
a.d skills to over 4.000 elementary and high school students, teachers,
parents and business personnel. The grant also provided for the training
supplies necessary for the instructors to teach the classes as well as
materials for those who were being trained to provide bystander and first
responder life saving skills in an emergency situation.
Number of Persons Directly Benefiting or Served by the Project: ^

Amount of Federal Match Funds Expended on the Project: $ -0-
Amount of Local Match Funds Expended on the Project: $ ••-0 -
on (nOt
authorized representative's) knowledge and belief. <an" th"

./. SfiiXXMA/ . THle_i>
(Print/Type)
DIVIDER
Illinois Deoartment of Commerce and Community Affairs
George H. Ryan
Governor Pam McDonough
Director
TO: Carol Spizzirri

Save a Life Foundation, Inc.
FROM: Susan Boggs, Illinois FIRST Grant Management Unit

DATE: July 28, 2000
RE: Grant Appropriation
Project No.: HD0505

Appropriation Section No.: 1241
Amount: $25,000
Purpose: all costs associated with running the Blue Angels Life
Saving program** a
Legislative Sponsor: Capparelli
Please be advised that the

Susan Boggs
620 East Adams
Fax: 217/557-9Bfl3
Internet Address http://www.commerce.siate.il.us

620 Ent Adam Street
>*m R Thorrpion Center
Springfield Illnos 62701 J25 Wen Adans Street. Jrd Floor
100 W« Randolph Streti. Suite 3-400 2309 Weil Main
Sprin|Rekt Illinois 62704.1892
Chicago. Iffinoii 60601 Minon. IDmoil 62959
2I7.-7S2.75OO
Jli-314.7179
Fu J17/783-6454 »TDD SOO/785-6035 2I7/7BS-2MO
Fu JI2/SI4-4732.TDD S0CV419-0667
Fu 2I7OJ5-26I8.TDD 217/785-0211 Ttx. 6ISW7-I825 ■ TOD Relay 800/526-0844
Prilled on lUcyttod and RecytUble Paper
AGENCY:
* Please complete for EACH project
Caucus, r sr • o.:ngl, jiJator: D Senate Democrat House Democrat

D Senate Republican D House Republican
Bill #: HB.' '7 Article*: 75
Section #: 1241
Legis!c:..jsp ,c s): Capparelli

District* 13
Name of Gra- - r. Zave a Life Foundation, Inc.

Grantee's Ad :. 4825 N. Scott #74 A
1
City: Schiller Park
Cont£c: ;'=rs- £ 3rr-.;ee: Carol Spizzirri

Title cf ?. .-it- • -crsor. President
Con;..: ^ .
Apprcp-iatr - ,' io.i.t: $25,000
'- brie Jescription) all costs associnted with running the Blue Angels Life
Name
Title
Date
1) grantee/project Information
Legal Name of Grantee -5>^~ /?-
Name of Chief Executive: <***£■■*. SP,
City; State: ZIP+ 4:

(Mandatory)
County: Business Phone l2V7 ) 99-2 . ?
Far ) ? }£ - E-mail address:
Name of Project Contact/Administrator of Gtant {if other Am thiefexecutive affieer):
{Enter name cf the project contact person ifsomeone other Am grantee's chiefexecutive officer)
Tide Contact- Phone { )_
E-mail address:
TYPE OF ORGANIZATION (Check only one):
D Individual 0 Goremmental Entity

D Owner of Sole Proprietorship 1 I Nonresident »!**"
Q Partnership D Estate or legal trust
Q Tax-exempt
lj hospital or extended care facility
lax-exempinospuaiorexTenaeacareracuKy D Foreign
i_i corporation, partnership or trust
roieigncoiponoso.panneiwipori
D Corporation providing or billing medical and/or health CD Other- not-for-profit organiatioa-

care services
care services '
G Corporation NOT providing or billing medical and/or
health care services D Other.
SI Not-for-profit Corporation
D Medical & Health Care Provider Corporation (Ifnot-for-
profit, please inchtde a separate list ofallboard members)
/Yr-3
For rntirire other *h*n gygr indicate riw ywr that thf orgiini
O Attach documentation of Good Standing Status. {Avmiaileyhrm Ac ttmou Secretary of State's office.)
FEIN 4-__^---___l_IB_ii|^|||^|^||iv {9-<iiptfederal employer identificatum number)

Owner of FEIN: X^^r ^ c-sîf r<pts as£><#■?s<i><cs 3?/tsC ■
(NOTE: ftu imutjmtvzdV Ae fEWnumber of the entity that willJinctty receive the grantfundsfrom DCCA. Do not use the FEIN
number ofany sultgtuiucc or affiliate of the grantee.)
page 2 |—
m First-—
the space below to provide a detailed description of the Project, wftic* mfl 6eA«W *X the grant [p.
^ «**«■* ^hprntntliAxmy of programs and sennces [mduding
SCOPE OF WORK
The purpose of the5/«^«^/v program will provide "train the trainer" instruction to '
or
taSff A? T ?? 6Sta: h a ^g elationshiP with the Boards of Educati

^°rking relationshiP Education
^ tChT Ol dlSt?f'l dr teacherS' parents' P°lice "d sch°d bus drivers
"inn t, PUrP°Se °^,demf
PUrP.°Se °^demf nStrating
schools The campa,gn will rec
^ savinS skills to the students
studt ini Chicago
Chi
300 Police instructors to outreach to 2500 of their
anc:
S ALF Instructors will deliver "c ight" basic LFS A training to the police volunteers
Those police officers vokinteeu for the Blue Angels program will need some prior
medical background. This back, ,und can be in EMS services, paramedic worlc CPR
training, or prior nursing experi; e. ^
The funds will be used for the cc of supplies, including mannequin sets, training
manuals, emergency bystander L and completion cards. Additional costs will include"
the cost of training 30 instructors *.nd administrative costs
page 3
hisgrantwflbefâsodals^
th questions 3 & 4. If you ait not a social service provider, please skip to question 5.
3) Describe any eligibility criteria for participation in your program [i^mcomeleytS. age. employment statjs, etc.):
///A- ■
4) Provideadetaaeddescriptionofc a) your program's goals; and b)iservices providedIto ^^"^""*£f

lôfeUgibiUty^nm^^
levels of eligibility (.
a)
b)
If your program is viewed tobe consistent with the goals of the federal Perso«dRespoi«baityaiid Work Opportunity R
Act of 1996 (PRWORA), further information may be requested.
5) Why is this project necessary? What is the expected benefit of this project (e.g«diy»ai no longer be mIEPA mtriatdstanu
list: unemployed persons w^reoirejob franm&eft)? 77^r" /&&<?'<?-<£: 7~ /£ &
6) Estimated Number of Persons to be Served/Benefited from Project:
page 4 |-
7) Attach copies of any public hearings, board meeting minutes, newspaper articles, or other documents that would
evidence local support for this project (âvailable). %#*'?'!> /*^f-^^>v^cc s*rs/
8) Do you anticipate any opposition to this project? D Yes 0 No If yes, please describe:
9) Timetable for Completion: Start Date &9 / aV / o £> Completion Date: '** I 3o lc^
(NOTE: Project should not begin prior to fufy 1,2000 and must be completed no later Aan June 30,2001)
a) Describe any actions/approvals that must be completed prior to the start of this project, with corresponding time
frames for completion:
b) Provide an estimated monthly expenditure of grant funds once the project starts:
Month 1: $ Month 13: $
Month 2: Month 14:
Month 3: Month 15:
Month 4: Month 16:
Month 5: Month 17:
Month 6: Month 18:
Month 7: Month 19:
Month 8: Month 20:
Month* Month 21:
Month 10: Month 22:
Month 11: Month 23:
Month 12: Month 24:
(NOTE: IncMeonty grantfunds in thUcstm mtnfy cashflow) not

Umber Initiative Grant Survey
10) When completed, this information will be incorporated into the grant agreement as the Project Budget Activities listed
in this budget should be consUtent with activities described in the Scope of Work. {See sample budgets on next two pages.)
^ BUDGET
ACTIVITY LINE ITEM GRANT AMOUNT OTHER PROJECT FUNDS

(if applicable)
1.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
TOTAUS
* For all personnel being paid in-full or in-part with Illinois First Grant Funds, a complete job description must be included.
»• This column cannot fflcwd the grant inwnt>> tn ^* "g»iw*i ftnm nrr*
■I page 6 |—
11) Other Funding: Are other funds necessary to complete this project? (jZlYes DNo
If yes, indicate the amount, source and status of those funds below:
• Amount of Federal Matching Funds: $ ■. :_ Status: O Approved. D Pending

(Name of Federal Funding Agency: .
Amount of Local Matching Funds: $ Status: D Approved D Pending

(Source of Local Match: t-
• AmountofotherStateFunds: $ *£& e«L*?e <"'■*** Status: DApproved DPending

(Name ofOtherState Funding Agency. s<£r<^r~ &&£'* c-S<£«P .
• List other Illinois FIRST grants this grantee is receiving this Fiscal Year (FT01Y.
• List any other grants this grantee received from DCCA within the last three years (Pmidt DCCA Grant Number):
This survey was completed by:
PrintedName
Signature
page 9
> Training Equipment: Mannequin sets - 43 mannequin sets at $100 each. Includes
30 Manuals - $1,500
412 Student Books - $824
400 Certificates - $400
430 pins - $860

> Director: $335
> Scheduler: $540
> MIS: $650
08/10/00 13:06 SRVE fl LIFE FOUNDflTION * 12175579883 m<215 p002

> Training Equipment* Mannequin sets- 43 mannequin sets at $100 each Includes
lungs and face shields - '
30 Manuals-$1,500
412 Student Books-$824
400 Certificates-WeO"©. 7y
30 Completion cards for Instructors-$30
30 Certificates for Instructors - 530
30 Instructor ID's -30 @ $5 each
30 Instructor shirts - $600 @ S20 each
430 pins -$860

> Director: $335
> Scheduler $540
> MIS: $650
> Instructor fees are die fees paid to both the "train die trainer" and the senior police
0*10/00 13:06 SflUE fi LIFE FOUNDRTION * 12175579883 N0.215 P001
Date: Wednesday, August 09,2000

Community Affairs
Susan Boggs
Phone: 217-782-5346
Fax: 217-557-9883

Carol J. Spizzirri
Phone: 847-928-9683
Fax: 847-928-9684
Pages: 2
Subject: $120 error on both applications
Correction of $120 reflected on Certificates as follows.

Car phone #847-612-5730.
I'll be in Springfield all day if you need me, I'll be right

over. Sitting up at the State Fair in the Fire Marshal's
Tent or at our office at St. John's Hosp. Thanks, Carol
GENERAL ASSEMBLY
/ ' STATE OFJUJNois
f. ■■
June 7,2000
Ms. Carol J. Spizzirri - President

Save A. Life Foundation, Inc.
4825 N. Scott St, Suite 74-A
Schiller Park, IL 60176
Dear Ms. Spizznru.
You have been selected to receive a $50,000.00 grant for the "Blue Angels" Life Saving Program
through a legislative initiative sponsored by our offices from the 2000-2001 Illinois State budget
There are several things that need to be emphasized regarding mis legislative initiative. First,
since the money for your grant is coming from the Fiscal Year 2001 Illinois State budget, the
funding will not be available until after July 1,2000. Second, although July 1,2000 is the first
day that the funding for legislative initiative is available, it will be several months before you will
actually receive the money for your grant This is due to the process that each grantee must go
through before an actual check can be cut and usually takes several months to complete. This
process has been established by the Governor's office and includes the following steps:
After the project is released by our offices, a letter goes out to the agency handling the grant,
which we believe in your case is the Department of Commerce and Community Affairs (DCCA),
the Governor's Office and the Bureau of the Budget, indicating our desire to move forward on the
legislative initiative.
DCCA should then send you a project survey form that asks for a detailed description of your
project for their evaluation. After the project survey form is returned to DCCA and the program
staff who is handling your grant finds no problems with it, the agency should forward the request
for release of funds to the Governor's Office. If there are problems with the project survey form,
the program staff at DCCA should be in touch with you to resolve those problems so that the
request can be forwarded to the Governor's office as soon as possible.
Once the Governor's office reviews the project and issues a release, DCCA should send you a
grant agreement package which needs to be looked over and read carefully, signed and returned
to DCCA as quickly as possible. After the signed grant agreement is received at DCCA, a
voucher should be issued and sent to the Comptroller's office for processing. The Comptroller's
office should then send you a check in a matter of days for the amount of your grant
Racyclad pspar - soybaan Ink

If your project is being issued from bond funds, such as the Capital Development Fund, there are
some additional steps in the process. First, bond fund releases need to be approved by the Bureau
of the Budget This step occurs before the Comptroller can issue a check. Second, you will only
receive half ofyour grant amount up front, if the grant is from bond funds. The other half of your
grant will be issued on a reimbursement basis, with the agency's receipt of your "quarterly
report". This report should be included in your grant agreement package with instructions on
how to proceed. la addition, the program staff member from DCCA should be helping you along
during every step in the process and should inform you of bow your grant will proceed at each
juncture.
This process can be frustrating, so your patience is required. If you are having problems or need
assistance, please call any one of our offices and we'll see what we can do to help.
Sincerely,
Walter W.Dudycz Ralph Capparelli

State Senator, 7* District State Representative, 13th District
FonnBCA-5.10
NFP-105.10' ..-*■**.'
(Rev. Jan. 1999)
Jesse White --• "*"?-:■>- '"■•.""

Secretary of State
Department of Business Services
SUBMITIN DUPLICATE
Telephone (217) 782-3647
http://www.sos.state.il.us
. This space for use by
. Secretary of State
/,-•. -/»-■>» Date
STATEMENT OF
CHANGE
OF REGISTERED AGENT! -'Approved:
AND/OR REGISTERED
,. Remit payment in check or money order,
OFFICE TSi payable to 'Secretary ofState.'-■■.'
■ .■<?-."•■
Type or print in black ink only.

lee reverse side for signature(s).
1. CORPORATE NAME Save A Life Foundatign
'Illinois -.-'
2. STATE OR COUNTRY OF INCORPORATION:
3. Name and address of the registered agent and registered office as they appear on the records of the office
of the Secretary of State (before change):
_ . . .. . Carol Jean * - Spizzirri
Registered Agent
First Name . Middle Name Last Name
15 Commerece Drive
Registered Office
Number Street Suite No. (A P.O. Box alone is not acceptable)
Grayslake, II 60030 . Lake
. _ City . ~ ZIP Code County
4. Name and address of the registered agent and registered office shall be (after all changes herein reported):
Registered Agent Caro1 Jean Spizzijfri
Registered Office 4825 N. Scott, St. , Suite 74-A
Number Street Suite No. (A P.O. Box alone is not acceptable)
Schiller Par*, II 6017«* Cook
City ZIP Code County
SECRETARY OF STATE OF ILLINOIS
FILE PRIOR TO 02-01-99 00 NOT WRITE IN THIS SPACE
^ ADD S3-00 PENALTY
ANNUAL REPORT
• ? FOR LATE FILING
RUNG FEE S5.00
7
1.) SAVE A LIFE FOUNDATION, INC.
■X CAROL JEAN SPUZIRRI 020993 061 b
17479 W DARTMOOR •
GRAYSLAKE, IL." 60030
LAKE
2.) NOTE: DO NOT ALTER ITEM 1. ^
Form NFP 105.10 must be filed in this office in order to change THE REGISTERED AGENT and/or REGISTERED OFF
3) The above corporation organized under the laws of the state of ILLINOIS . pursuant
provisions of "The General Not for Profit Corporation Act" of the State of Illinois, hereby makes the following report:
4.) THE NAMES AND RESPECTIVE RESIDENTIAL ADDRESSESS OF ITS OFFICERS AND DIRECTORS ARE:
NAME
Carol J._-_Spiz2irrJ
«2aroL J.-Spizzirra
NOTE:. List all directors above or list them on an additional sheet Illinois corporations must haveTHREE directors.
5.) The following is a brief statement of the character of the affairs which the corporation is actually conducting:
Training/education in Life Supporting First Aid and emerg. preparedness
p
6.) Is this corporation a CONDOMINIUM Association as established under the Condominium Property Ad?
d?
Yes [] No [x] (CHECK ONE)
Is this corporation a COOPERATIVE HOUSNG CORPORATION defined in Section 216 of the Internal Revenue Code of 1954?
. Yes Q ; No Q (CHECK ONE) •
Is this a HOMEOWNER'S ASSOCIATION which administers A COMMON-INTEREST COMMUNITY AS DEFINED IN SUBSECTION (

of Section 9-102 of the Code of Civil Procedure?
. Yes Q - No jx] {CHECK ONE)
7.) If a foreign corporation, the address of its principal office in the state of its incorporation is:
(Number ana Street) (State or Country)
read reverseîdR of this report before signing belowi
dasanaumonzMaHietr.il
8.) BY
IB annual (toon, punuara to preMsiens d on GtntnU H
a O/ficirs Signature) CoreonMn Aa. nas Bxn namnttf Or <f and is. M im
momiagi and a**, try, coma, ana camowt.
u
ITEM 8 MUST BE SIGNED
C 5* 16
5. The address of the registered office and the address of the business office of the registered agent, as changed,
will be identical. •- •-••Mr ... ... ..
6. The above change was authorized by: ('X" one box only)
a. D By resolution duly adopted by the board of directors. (Note 5)
b. (2 By action of the registered agent (Note 6)
NOTE: When the registered agent changes, the signatures of both president and secretary are required.
7. (If authorized by the board of directors, sign here. See Note 5)
.-■The undersigned corporation has caused this statement to be signed by its duly authorized officers, each of
whom affirms,under/penalties of perjury, that the facts stated herein are true.
Save A Life Foundation,- inc.

(Year) f\ \\i\ (Exact Name of Corporation) — "■
(Signatore ohPfe&dent or Vice President)

Carol A. Spiyzirri>pr4sident
(Type or Print Name and Title) (Type or Print Name and Title) ^~: '■"• '-' :'j
.. : :v:r . , • ■••7 r.-.£ S3-....:.
(If change of registered office by registered agent, sign here. See Note 6) "' " *' " * * ~": — •-
The undersigned, under penalties of perjury, affirm^ that the facts stated herein are true? "-
Dated January 30 ^1999 -

(Month & Day) ... . ■ : "■.: O'ea^ • .'' fS/gbafur* oil Registere
igistered Agent of Record)
^__ ,___._ pT. .,.

1. The registered office may, but need not be the same as the principal office of the corporation. However, the
. . registered office and the office address of the registered agent must be the same. .. .■i,: „..-..—
2. The registered office rnustinclude a street orjradaddressTa post office box numberalbne Is"n6t: acceptable.
3. A corporation cannot act as its own registered agent .: - ■ .
4. If the' registered office is changed from one county to another, then the corporation must file with the recorder
of deeds of the new county a certified copy of the articles of incorporation and a certified copy of the statement
of change of registered office. Such certified copies may be obtained ONLY from the Secretary of State.
5. Any change of registeredagentmusX be by resolution adopted by the board of directors. This statement must
then be signed by the president (or vice-president) and by the secretary (or an assistant secretary).
6. The registered agent may report a change of the registered office of the corporation for which he or she is
registered agent. When the agent reports such a change, this statement must be signed by the registered
agent.. . .... ,.'".'... ■
cLgg op INCORPORATION OF
. SAVE A LIFE FOUNDATION/ INC»
INCORPORATED DNDER THE LAWS OF THE STATE OF ILLINOIS HAVE BEEN
FILED IN THE OFFICE OF THE SECRETARY OF STATE AS PROVIDED BY THE
GENERAL NOT FOR PROFIT CORPORATION ACT OF ILLINOIS, IN FORCE
..JANUARY 1, A»D. 1987 »
a, fl
ojsthe, a
9TH
FEBRUARY 19
the, fata* AunctfecCancu_ 17TH
SECBETAHY
O212
(Revised 5-88)
SUBMIT IN DUPLICATE °«e £-
Payment must be made by Certified Check, Cashier's
Check, Illinois Attorney's Check, Illinois C.PA's Check Rl1"9 Fee S50
or Money Order, payable to 'Secretary of State.' Annn*/»d

DO NOT SEND CASH!
TO:. GEORGE H.RYAN, Secretary of Slate ;■•■■•■
Pursuant to the provisions of "The General Not For Profit Corporation Act of 1986", the undersigned incorporator(s)
hereby adopt the following Articles of Incorporation.
Article 1. The name of the corporation is: SAVE A LIFE. FOUNDATION. INC.
Article 2: The name and address of the initial registered agent and registered office are:
Registered Agent. Soizzirri

Registered Office. 17&7Q TJ

Number Street (Do Not Use P.O. Box)
CravsTake. 60030 Lake
Otf . ZipCode County
Article 3: The Bret Board of Directors shall be __ 3 in number, their names and residential addresses
being as follows: (Not less than mree)
Address
Director's Names Number Street Cltv
Carol J. Spizzirri
Sandra L. Engberg
Lee E. Jungkans
Article 4. The purposes for which the corporation is organized are:
To promote basic emergency first aid and CPR for all public servants,
Is this corporation a Condominium Association as established under the Condominium Property Act?
□ Yes g]No (Check one)
Is this corporation a Cooperative Housing Corporation as defined in Section 216 of the Internal Revenue Code
,of1954? DYes E]No (Check one)
Is this a Homeowner's Association which administers a common-interest community as defined in subsection

(c) of Section 9-102 of the code of Chril Procedure? □ Yes H No
Article 5. Other provisions (please use separate page):

of this Proposal Form. The undersigned further agrees thai if any significant adverse changejrt'ihe condition 01 tne
applicant is discovered between the date of this Proposal Form and tha affective date of the Policy, which would render
Ihis Proposal Form inaccurate or incomplete, notice of such change will be reported in writing to the Insurer immediately.
The signing of this Proposal Form does not bind iha undersigned to purchase the insurance, but it is agreed that this
ProposalForm and any material submitted therewith are their representations and that they are material. It is further
agreedxhat this Proposal Form and any material submitted therewith shall be the basis of tha contract should a Policy be
issued, and this Proposal Form and any attachments thereto will be attached to and becoma a part of tha Policy.
Data t>. IQ ?£
.Title
*A POLICY CANNOT BE ISSUED UNLESS THE PROPOSALFORM IS PROPERLY SIGNED AMD DATED.*
A copy of each of the following documents will be provided at the time the completed Proposal Form is submitted.
a. COMPLETE COPIES OF THE ORGANIZATION'S LATSSTTWO ANNUAL REPORTS OR ANNUAL

AUDITS/EXAMINATIONS.
b» COPY OF THE ORGANIZATION'S ARTICLES OF INCORPORATION/CHARTSR.
. a CQPY"OFTHEORGANrZ'VnON*S! BY-LAWS- • .
It is representedthatthe particulars and statements contained In the Proposal Form are true and are the basis of this
Policy and are to b& considered as Incorporated in and constituting part of this Policy.. However, this Policy shall not be
voided or rescinded and covsrage shall not be excluded as a result of any untrue statement in the Proposal Form, except a;
to those persons making such statement or having knowledge of its untruth.
Karen S. Crane Date

Submitted by
(M00UCSA1
JMB Insurance Agency, Inc., 900 North Michigan Avenue, Suite 1700. Chirac. TT,
NOTE: •: This Proposal including any material submitted therewith shall be treated in strictest confidence.
SEECIAL RISK*
5QQ WEST M0HEOE: 50TEE ZOZO
Tbooei 312-474-0400
Vox: 3L2-474-4404
Board ofDirectors Meeting
June!5, 2000
Held at the offices of:
Lavelle, Motla, Klopfenstein & Salelta, LTD.
9240 Wesl Belmont Franklin Park, Illinois 60131
Present Members: Carol J. Spizzirri, president. Honorable Sam Amiranlc, Bob Conroy. Martin Sandoval, Scott Anderson, Michael Lavelle. Deloris
Ijurnam. Scott Belzclos, MD., Carlos Cortes
Absent Members: Stan Zycllo. MO
Guest:
Present: Bob Motta esq.
Tonic Discussion Action
Cat! Meeting to Order > Carol Spizzirri called board meeting to order.
(On tape 1 side I from 000-003)
Minutes of April 20,2000 > Carol Spizzirri for Deloris Burnham who was absent > Carol motioned for the minutes to be
(On tape I side I from 004-011) accepted as present. Hon. Sam Amirante,
seconded, motion passed.
Financial Report > Carol Spizzirri for Scott Anderson > We will not be getting our fiscal year
(On tape 1 side I from 012-450) money until mid September for 2001.
Carol motioned that SALF would have to
generate a loan for SI00.000. Sam
Continuing discussion about the loan Amiranle second the motion. It was carried
> Carol made a motion to accept Martin

Sandoval as a member of Board of
Directors. Martin spent 16 years with the
Federal Government. Currently
Commissioner on County Board of Water
Reclamation, First Latino on the Water
Board, First Democrat appointed by
> Nominations of: Martin A. Republican to the board. Nine years
Sandoval, Margie Lawless, Carol Spizzirri presents the nominations of: studying at a seminary for the priesthood.
> Martin A. Sandoval Lost his sister 2 years ago. Lavelle second
Robert Molta to the Board of
Directors (On tape I side I from 451-547) the motion, motion was carried. Martin was
accepted to the Board of Directors. .
> Carol made a motion to accept Margie

H:\BOD Minutes 8-00.doc

■ ■:. ■ Lawless as member of Board of Directors.
Margie Lawless is a Vice President of Harris
Bank. Motion moved by Carol Spizzirri,
motion second it by Sam Amirante.
Carol Spizzirri also nominates Margie Lawless
(On tape I side I from 548-615)
> Carol motion forBobMotta to be on the
Board of Directors. Sam Amirante denied
the motion. Motion was dented.
> Bob Motta
Bob Conroy motioned to allocate SALF

staff members to work on the Branch
Development Committee in the main office.
Old Business
Jodie and Hank, as the office contacts, have
SALF Branches to report back to the Committee. Motion
> New Branch request Bob Conroy seconded by Carlos Cortes, motion carried.
proposals (On tape I side 2 from 000 -648)
Discussion continues about the branches
Carol Spizzirri made motion to have Martin

Sandoval, Michael Lavelle, Sam Amirante,
and Carlos Cortes to serve on a Public
Relations Committee to flnd a company that
would fulfill our purposes to their best
interest Michael Lavelle was appointed to
chair this Committee,' he accepted the
motion. Motion was carried.
Carlos Cortes made motion to be the

> Blue Angels Director of the Blue Angel Committee. He
> Carlos Cortes and Wayne Wiberg will put an ad in the FOP newsletter to get
(On tape t side 2 from 649-700) Police officers to become Instructors. The
newsletter reaches 16 thousands Poiice
Officers. The Police officers will require
some medical background. Carlos and
Wayne will create a logo with the Save A
Life shield and Angel wings on it. That is
going to called Blue Angel's Squad".
H:\JBOD Minutes 8-00.doc

earoi aaaea mat both Senator Walter
The discussion continues
Dudycz and Rep. Ralph Capparelli have
(On tape 2 side 1 from 000-024)
allocated 50 thousands dollars towards the
Blue Angels out of their funds. We should
be receiving that money in September,
which will only serve the purpose of the
Blue Angels. The Senator offered to chair
the Blue Angels. Motion was seconded by
Mike Lavelle, and carried.
Bob Motta reports

> Mattel Law Suit (Ontape2side I from 025-188)
A complaint was filed against Mattel on
June 8llu2000. At this point we're in the
holding matter to see how Mattel is going to
respond. There was a press release that was
drafted. Scott Peterson and Bob Motta
reviewing it.
New Business
Board Responsibility questionnaire (Next Board

Board Productivity meeting)
and Redevelopment (On tape 2 side 1 from 199-540)
New policy/Committee procedures
(Tabled to next Board meeting) Carol motioned to have Board Development
Committee Nominations Committee. Motion was seconded by Sam
(Tabled to next Board meeting) Amirante.
Position for September Election

(Next Board meeting)
Closing of the Meeting Spizzirri made a motion to close the meeting Motion was seconded by Scott Anderson and
Until August 17,2000 at 6:30 pm @ Motta's office carried.
H:\BOD Minutes 8-00.doc

Honorary Chairman
David Hasselhoff, BAYWATCH Productions
Hon. Rep. Mike McAuliffe, IL, App-Public
Illinois States Spokesperson Safety, Transportation
Hon. Jesse White, IL. Secretary ofState William Nolan, FOP, President, Chicago
Ldg.lt 7
Illinois Ambassador Hon. Sen .Steve Rauschenberger, IL
Mrs. Lura Lynn Ryan
Medical Director
Board of Director Stanley Zydlo, M.D, Director, Rush
Carol Spizzirri. President/FounderSALF Hospital's E. R., Aurora, IL
Hon. Sam Amirante, Associate Judge of the
Circuit Court of Cook County
Scott Anderson, President, Anderson Business
Machines Associate Medical Director
Scott Betzelos, M.D., FA.C.E.P., Medical Scott Betzelos, M.D. F.A.C.E.P., Medical
Director, St. Elizabeth Hospital'sER.
Director. St. Elizabeth Hospital'sE.R.
Deloris M. Burnam, Coordinator, Chicago
Medical Advisors
Regional PTA
Robert Conroy, President, Green Bak
Nicholas Bircher, M.D. SRC. Unv. Pitts
Uwe Ebmeyer, M.D. Germany
Publishing Co.
Henry Heimlich, M.D. OH
Carlos Cortez, CPO, Chaplin, Chicago Police
Academy
Mark Mitchell, M.D., Director. St. John's
Hospital ER., Springfield, IL
Michael Lavelle. ESQ.,, Lavelle, Motta,
Klopfenstein & Saletta, Ltd.
Emest A. Pretto, Jr. M.D. VA Hosp. SRC Pitt
Margarette Lawless, VP, Harris Trust and Mikel Rothcnberg, M.D. EMS Educator, OH
Savings Bank Peter Safar, M.D. Professor SRC. Unv. Pitts
Robert Boyd Tober, M.D. FACEP Dir.EMS. FL
Martin Sandoval, Commissioner,
Paula Willoughby, Chicago Fire Department
Metropolitan Water Reclamation Dist
Medical Director
Greater Chicago.
Wayne Wiberg, Chicago Police Department,
CPR/First Aid, Instructor
Stanley Zydlo, M.D., Director, Rush
Hospital's E. R., Aurora, IL
Legal Council
Robert Motta ESQ., Lavelle, Motta,
Klopfenstein & Saletta, Ltd.
Advisory Council
Hon. Rep, Ralph Capparelli, IL
Hon. Sen., Walter Dudycz, IL
US Sen. Richard Durbin, IL
David Fortnan, President, Association ofFire
Fighters ofIllinois
Dan Fortuna, Chicago Fire Fighters Union
U2, Public Relations Director
BUl.Kugelmen, President, Chicago Fire
Department, Local 2 Union
SALF Blue Angels Program Job Descriptions for DCCA Grant Survey
SALF Trainers: Provide the "train the trainers" instruction to Police instructors with
certified training in basic hands-on Life Supporting First Aid (LFSA) and
cardiopulmonary resuscitation training, using demonstration mannequins and first aid
kits. Trainers will conduct post-training tests and issue completion certificates.
Blue Angels Trainers: Train fellow police offices with certified training in basic hands-
on Life Supporting First Aid (LFSA) and cardiopulmonary resuscitation training, using
demonstration mannequins and first aid kits. Trainers will conduct post-training tests and
issue completion certificates. SALF's Blue Angels will also work with the Chicago
Board of Education to provide LFSA and CPR training to school children.
SAVE A LIFE FOUNDATION
Training Equipment for Trainers:

2 mannequin sets
1 instructor shirt
1 Identification badge
1 training manual
2 bystander kits
Supplies issued to each new student:

1 program book
1 course completion card
1 bystander kit
Number of people: 30 police instructors to serve as SALF trainers.
Instructor fees: $25

ill Z)OI 3CCO
Nov-U-2000 15:52 Frcm-DCCA IL FIRST 217-557-9883 T-915 P.002 F-732
George H. Ryan ' Pun McDonough

Gwernor Director
November 14, 2000
Ms.' srol Spizzirri

Pres, .'ent/Founder
Dear Ms. Spizzirri: .
Enclosed please find Grant Agreement Number 01-120390 between your organization
("Grantee") and the Illinois Department of Commerce and Community Affairs
("Department"). Please review the Agreement carefully to ensure that the Grantee's
rights and responsibilities are clearly understood. You are encouraged to have the
Agreement reviewed by an attorney. In particular, please note the following:
Beginning Date (Notice of Grant Award). Costs incurred prior to the specified
beginning date are not eligible for reimbursement, unless such costs have been
identified in the Project Budget and approved by the Department.
End Date (Notice of Grant Award). The Project must be completed by the stated
end date. Modifications for scope of work changes or date extensions must be approved
in writing by the Department and processed prior to the stated end date.
Part II • Special Conditions. Part II requires specific acknowledgment by and

acceptance of the Grantee of all obligations set forth therein. The Grantee is expected to
be thoroughly familiar with the provisions of Part II, including requirements regarding
the submittal of reports, authenticating documents, etc.
If the terms of the Agreement are acceptable, please complete the following steps in
order to properly execute the Agreement:
• verify the Grantee's correct federal taxpayer identification number (FEIN) and
correct legal/business status in the appropriate blanks on pages 1-2;
• have an authorized official of the Grantee execute page 2 of the Notice of Grant
Award anil the acknowledgment set forth in Part II;
Internet Address hnp://www.commcrce.siatc.il.us

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Nov-14-2000 15:52 Froa-DCCA IL FIRST 217-557-9883 T-915 P.003 F-732
• make any necessary corrections to the Grantee's address; fill in the name, phone
number, and address (if different from the Grantee's address) for the
administrator/project manager; and
• please review Section 6.6 carefully and mark the statement with an "X" as it
relates to the Grantee.
• if "Grantee Disclosures" are required by the Department, the disclosures must

be completed, signed by an authorized official of the Grantee organization and
returned with the executed Grant Agreement
The Grantee's ability to incur costs against the Grant as of the beginning date set forth
in the Notice of Grant Award is contingent upon the Grantee's acceptance of the terms
and conditions as set forth in the attached Agreement. The Department may elect not
to execute the Agreement if any of the terms are changed without the Department's
prior approval, and the Grantee will be responsible for any costs already incurred.
The Department may also elect not to execute the Grant Agreement if it determines that
it is not in the best interest of the State of Illinois to do so. Written notification of such a
determination and the basis therefor will be provided to the addresi.ee of this letter in
such event.
IMPORTANT INSTRUCTIONS: Please return the ENTIRE SIGNED ORIGINAL document

to the individual indicated in Exhibit 2 of the Grant Agreement. Please direct any
questions concerning the Agreement to the individual identified in Exhibit 2.
ADDITIONALLY, the forms to be utilized in preparing reports required by Part II of the

Agreement are also provided in this packet. Reports will not be accepted unless these
forms are used.
You will be provided with a fully executed copy of the Agreement aft-sr it has been signed
by Director McDonough.
Sincerely,
Susan Boggs
Illinois FIRST Grant Manager
Enclosures
GwAXff
GOVERNOR ' PAM
DIRECTOR
November 21, 2000
Ms. Carol Spizzirri

Pres/Founder
4825 N. Scott St.
Ste 74-a
Re: Grant No. 01-120390
Dear Ms. Spizzirri:
Enclosed is your fully executed copy of the grant agreement

between your agency and the Department of Commerce and Community
Affairs (DCCA). Please retain this copy in your files for reference
during the administration of the grant and for future audit and
monitoring purposes.
If you have any questions regarding your grant agreement,

please contact your DCCA Grants Manager.
Sincerely,
Pam McDonough
Director
Enclosure
m I
STATE OF ILLINOIS
DEPARTMENT OF COMMERCE AND COMMUNITY AFFAIRS
Notice of Grant Award No. 01-120390

LEGISLATIVE ADD ONS
This Grant Agreement (hereinafter referred to as the "Agreement")

is entered into between the Illinois Department of Commerce and
Community Affairs (hereinafter referred to as the "Department") and
(hereinafter referred to as the "Grantee)". Subject to terms and

conditions of this Agreement, the Department agrees to provide a
Grant in an amount not to exceed $25,000.00 to the Grantee.
Subject to the execution of this Agreement by both parties,

the Grantee is hereby authorized to incur costs against this
Agreement from the beginning date of 07/01/2 000 through the ending
date of 06/30/2002. The Grantee hereby agrees to use the funds
provided under the Agreement for the purposes set forth herein and
agrees to comply with all terms of this Agreement.
This Agreement includes the following sections, all of which are

incorporated into and made part of this Agreement:
Part:
I. Budget
II. Special Grant Conditions
III. Scope of Work
IV. Program Terms and Conditions
V. General Provisions
VI. Required Certifications
Under penalties of perjury, the undersigned certifies that the name,

taxpayer information number and legal status listed below are correct.
If you are an individual, enter your name and SSN as it appears on your
Social Security Card. If completing this certification for a sole
proprietorship, enter the owner's name followed by the name of the
business and the owner's SSN. For all other entities, enter the name
of the entity (as used to apply for the entity's EIN) and the EIN.
Taxpayer Identification Number:

SSN/EIN :j
11/14/2000 14:28:24 - 1 -
Nov-I4-2000 15:53 Froa-DCCA IL FIRST 217-557-9883 T-915 POOS F-732
Legal Status (check one) :
Individual _____ Government entity

Owner of sole proprietorship Nonresident alien individual
Partnership Estate or lecjal trust
Tax-exempt hospital or Foreign corporation
extended care facility partnership estate or trust
Corporation providing or
4 Other - not-j.:or-profit
organization: ^___
Corporation NOT providing or Other:

The Grantee acknowledges that the individual signing below is authorized

to execute this'Agreement and that such signature constitutes the
acceptance of this Agreement.
GRANTEE:
2.21^1
Tyjii
STATE OF ILLINOIS DEPARTMENT OF COMMERCE AND COMMUNITY AFFAIRS

By:
Pam McDonough, Director Date
Grantee Address:
Please indicate any changes below
4825 N. Scott St.
Ste 74-a
T7
Chief Exec: Carol Spizzirri

Phone: (84 7) 928 - 9683
The following is designated as administrator for the Grantee:
Chief Exec:
Phone:
11/14/2000 14:28:24 - 2 -
PARTI
BUDGET
Activity Line Item Grath^No. Grant No.
NOTE:
IN THE EVENT THIS BUDGET REFLECTS EXPENDITURES FOR THE PROJECT

DESCRIBED IN PART III WHICH THE GRANTEE HAS ADVISED THE DEPARTMENT ARE
ANTICIPATED TO BE PROVIDED THROUGH ADDITIONAL GRANT AWARDS GRANTEE
ACKNOWLEDGES (i) THAT THE AMOUNT OF FUNDS TO BE DISBURSED UNDER THIS
GRANT WILL NOT EXCEED THE AMOUNT STATED IN THE NOTICE OF GRANT AWARD
FOR THIS GRANT; AND (ii) THAT THE DEPARTMENT'S OBLIGATION TO DISBURSE
SUCH OTHER FUNDS IS CONTINGENT UPON FINALIZATION OF A GRANT AWARD AND
EXECUTION OF A GRANT AGREEMENT FOR THE ADDITIONAL FUNDS
PART Il-Bl
SPECIAL GRANT CONDITIONS

(NON-GOVERNMENTAL ENTITIES)
(Non-construction)
2.1 AUDIT REQUIREMENTS.
The Grantee is required to have an audit conducted as provided in Part V

Section 5.4C, Audit Requirements. The audit must include a Revenue
(Receipt) and Expenditure Statement comparing budgeted amounts with
actual for this grant. The audit must also include a compliance component
which covers, at a minimum, the following items:
• did the Grantee complete the activities described in the Scope of Work
(Part III) within the Grant Term P
• did the Grantee obtain prior written approvals from the Department for
material changes from the performance of the activities described in the
Scope of Work (Part III)
• did the Grantee expend grant funds within the grant period specified in the
Notice of Grant Award
• did the Grantee adhere to the grant Budget (Part I); if not, variances
should be identified
• did the Grantee obtain prior written approvals from the Department for any
material variances in its expenditure of grant funds
• did the Grantee adequately account for receipts and expenditures of grant
funds
• if applicable, did the Grantee return grant funds to the Department in

accordance with the provisions of the Grant Agreement
• are amounts reported in the Grantee's close-out package traceable to its

general ledger
The Grantee is not required to have an audit conducted as a condition of this

Grant Agreement; however, if the Grantee receives during the term of this
/am A?reement (°r has Previously received), additional grants from the State
of Illinois for the project described in Part III hereof, the Grantee shall be
required to have an audit conducted as provided in Part V, Section 5.4C(a¥iv)
hereof.
22 PROJECTS REQUIRING ErrrpflV|
AGENCY SIGN-OFF SIGN-OFF

Illinois Historic Preservation Agency Î"™ 0UTSTAND'Ne
Illinois Dept. of Agriculture —
Illinois Dept. of Natural Resources —
NONE APPLICABLE — —
THB Hn)LeXtemal ?''g,n;Off iS outstandin& the provisions of Exhibit 1 apply with resoect
to the disbursement of funds under this grant. respect
!to comply
that awith
fLgn*Off has been recelved jn no waV "-elieves the Grantee of its
any conditions or requirements conveyed b7 S
^TJUnCtl°n ^ *" iSSUa"Ce f th ^
^ ^^SS
PROVISIONS: PR.QP ,Mr,,porn ^cTc. Jhe D rtment $ha
^ C°mptroller>s Office t0 dis^rse payment of the g'anMunds as
scheduie f°r the b— - ws

!Lh2hrnalHignOffS areuindicated in Section 2.2, above, disbursement of grant funds
whether advance or scheduled) are subject to the restrictions set forth in Exhibit 1
PeCeiHPt K°f a" reqêd Sign-°ffS' the D^ment's Account ng Division, wil be
herein **** ^ j" accordance with the disbursement method indicated
l°n!l Tpe DeKpartment reserves the rjght to adjust the disbursement schedule set forth
above. Re.mbursement of costs incurred by the Grantee prior to the Beginning Date
specified in the Notice of Grant Award requires the approval of the Department Such
costs must be clearly identified in Part I hereof.
24 PROJECT COMPLETION DATE: FUNDING LlMmmnw The Project Completion

Date for this Grant is the end date stated in the Notice of Grant Award. -
The grant awarded pursuant to this Agreement is a one-time award. The State is not
obligated to provide funding in subsequent State of Illinois fiscal years for the project
funded by this grant.
2-5 REPORTING REQUIREMENTS. In addition to any other documents specified in

this Agreement, the Grantee must submit the following reports and information in
accordance with the provisions hereof.
<a> Grantee Disclosures/Authenticating DnrumAqtc The Grantee must complete

and submit Grantee Disclosures if required by the Department as a condition of
receiving this grant. The Department reserves the right to exercise its sole discretion in
determining whether a potential conflict of interest, or the appearance thereof is
indicated in the Grantee Disclosures or through other information the Department
obtains. If the Department determines a potential conflict of interest, or the appearance
thereof, exists in connection with the issuance of the proposed grant to the Grantee the
Department reserves the right to accept a cure of the potential conflict of interest or to
cease any further consideration of the proposed grant. Additionally, the Department
reserves the right to make its execution of this grant agreement contingent upon the
Grantee's submittal to the Department of authenticating documents that relate to the
Grantee's legal/business status, including, but not limited to, a certificate of registration
and a certificate of good standing issued by the applicable state authority.
Status/Expense Reports. Grantee shall submit status/expense reports as

indicated below.
•
_A_ Quarterly Reports: The Grantee shall submit a Quarterly Status Report
and a Quarterly Expense Report in the format provided by the Department.
Reports shall be submitted quarterly (on a calendar basis) through the
stated Grant end date.
_JL_ Final Reports: Grantee shall submit a Final Status Report and a Final
Expense Report in the format provided by the Department. The Final
Reports are due no later than 30 days following the stated Grant end date.
(c) Close-out Report- The Close-out report described in Section 5.4 hereof is due 45
days following the end date stated in the Notice of Grant Award.
<9 . Additional Information. Upon request by the Department, the Grantee shall,
within 10 business days of its receipt of such a request, submit additional written
reports regarding the Project, including, but not limited to, materials sufficient to
document information provided by the Grantee.
(e) Submma) of Reports. Submittal of reports and documentation required under
Section 2.5 should be submitted to the individual identified in Exhibit 2 hereto.
2.6 FUNDINQ RESTRICTIONS, For purposes of this Section 2.6, the term "principal-
means a partner, officer, director, board member, agent registered aeent or
shareholder of the Grantee, who currently holds such position or acts in such capacity o
who formerly held such a position or acted in such capacity within the 18-month period
rrfnt Z,rH6 c?mTnce™nt -?ate of *» *rantterm that is specified in the Notice of
Grant Award The term "family member" means the spouse, mother, father, sister
brother, son, daughter, son-in-law or daughter-in-law of anv principal Of the Grantee.
By executing this Agreement, the Grantee hereby certifies its compliance with the
following conditions:
(a) Grantee shall not use funding provided under this Agreement for sectarian purposes.
(b) Grantee shall not disburse grant funds to any principal or family member, except as
provided in Section 2.6(e) below. v
(c) Grantee shall not convey property purchased with grant funds to any principal or
family member Further, during the term of the grant agreement specified in the Notice
of Grant Award, Grantee shall use property purchased with grant funds solely for the
purpose of accomplishing the Project described in Part III.
(d) Grantee shall not enter into contracts for services or for the acquisition of personal
or real property to be paid from grant funds with any principal or family member, except
as provided in Section 2.6(e) below. H
(e) Grantee shall expend grant funds for payment only to employees or independent
contractors performing services for Grantee where the services to be performed and/or
the use of property are specifically identified in the Project Budget (Part I) and are
directly related to the activities described in the Scope of Work (set forth in Part III
hereof).
(0 Grantee shall not, without the express written consent of the Department disburse
any grant funds or convey any property purchased with grant funds, to, on behalf of or
for the benefit of, any registered lobbyist or family member of such lobbyist as the term
is defined in the Lobbyist Registration Act (25 ILCS 170/1 etseq.).
(g) Grantee has read and shall comply with the conflict of interest provisions and other
prohibitions set forth in Section 5.9 of this Agreement.
27 OPPORTUNITIES FOR MINORITY. FEMALE ANQ DISABLED PFRsnug Grantee

shall use good faith efforts to recruit, develop and extend employment and contracting
opportunities to women, minorities, and disabled persons from funds received under
this grant. Nothing herein shall be deemed to modify or negate any requirement of the
Business Enterprise for Minorities, Females and Persons with Disabilities Act (30 ILCS
575/1) or any other provision of this Grant Agreement.
Nov-14-2000 15:56 From-DCCA IL FIRST 217-557-9883 T-915 P.012/085 F-732
nai
29 ACKNOWLEPGWgNT, If requested by the Department the
335££55S£g!s
[E^1!»NAT<QN FQR CAHSF Grantee's failure to comply with any of the
55S£S3t^
—
s sis :r::n;2 3
SSr3SSSSfe
Sa w5SSSS£5L«=s? •"•
enl .\
[
DATE: kV,> LC
EXHIBIT 1
The Project described in Part III and funded under this Grant Agreement, is subject to
review by the external agency(ies) indicated in Section 2.2 hereof Grantee must cornpj
with requirements established by said agency(ies) relative to their respective reviews
Any requirements communicated to the Department shall be incorporated into this
Agreement as follows: (I) as an attachment to this Exhibit 1 at the time of Want
execution; or(ii) If received from the applicable ag,ncy(ies) subsequent o exeafton
as an addendum to this Agreement The Grantee is contractually obligated to comely
with such requirements. . . ■■«« w wompiy
Grantee is responsible for coordinating directly with the applicable external agencyfies)
re lat.ve to said rev.ews Except as specifically provided below, the Dep!rtment?s
obligation to disburse funds under this Grant Agreement is contingent upon notiSon
by the applicable agency(.es) that all requirements applicable to the Project have been
satisfied Upon receipt of said notification, disbursement of the grant funds shaH be
authorized in accordance with the provisions of Section 2.3 hereof.
Prior to notification of compliance by the applicable external agency(ies) the Grantee

may request disbursement of funds only for the following purposes administrltiv?
contractual, legal, eng.neenng, or architectural costs incurred which are necessary to
allow for comphance by the Grantee of requirements established by the external
PART III
SCOPE OF WORK
Section 1. Public Benefit
The Grantee is a nonprofit corporation providing instruction to the community in basic

hands-on life supporting first aid including cardiopulmonary resuscitation. Through the
Blue Angels program, the Grantee helps to promote the moral, ethical and
compassionate duty to act in another's behalf. This program will be enhanced by the
purchase of equipment and materials funded by this Grant.
3173 people will be trained as a result of this project.
Section 2. Grant Tasks
2.1 The Grantee will use Grant funds in accordance with Part I, Budget.
2.2 The Grantee shall continue to provide the programs and services specified in Section
1, above, for the term of the Grant Agreement.
PART IV
TERMS AND CONDITIONS GOVERNING GRANT
(Non-governmental Entities)
4.1 APPLICABLE TIME LIMITATIONS.
(i) Completion of Performance. All activities described in Part III hereof, which are
chargeable to grant funds provided by this Agreement, must be completed by the grant
period end date set forth in the Notice of Grant Award.
(Ii) Expenditure of Grant Funds. All grant funds provided under this Agreement must
be expended or legally obligated by the grant end date set forth in the Notice of Grant
Award. Grant funds not expended by the grant end date must be returned to the
Department in accordance with directions provided by the Department.
4.2 INTEREST ON GRANT FUNDS. Any interest earned on grant funds provided under
this Agreement must be accounted for and returned to the Department in accordance
with the directions provided by the Department.
4.3 REFUNDS TO THE DEPARTMENT. Any refunds (unliquidated grant balance,

interest earned on grant funds, or ineligible/improper grant expenditures) due the
Department shall be remitted by the Grantee upon demand and pursuant to instructions
issued by the Department.
4.4 BUDGET/SCOPE OF WORK MODIFICATIONS.
(i) Grant Budget (Part I). The Grantee must obtain prior written approval from the
Department for any expenditures which materially vary from the expenditures set forth in
Part I hereof. For purposes of this Agreement, "materially vary" means any variance
within the line items set forth in Part I which exceeds 10% of the amount established
for that line item or any line item added or substituted for a line item in Part I hereof.
(ii) Scope of Work (Part III). The Grantee must obtain prior written approval from the
Department before changing any of the activities specified in Part III which are
chargeable to this grant. Any revision to Part III which results in the performance of
activities by the Grantee which are inconsistent with the purpose set forth in the
Appropriation authorizing the grant awarded under this Agreement are not permissible.
4.5 FISCAL RECORDING/REPORTING REQUIREMENTS. The Grantee is accountable

for all funds disbursed under this Grant. The Grantee's financial management system
shall be structured to provide for accurate, current, and complete disclosure of the
expenditure of all funds provided under this Agreement. The Grantee shall maintain
effective control and accountability over all funds disbursed and, equipment, property,
or other assets acquired with grant funds. The Grantee shall keep records sufficient to
permit the tracing of funds to a level of expenditure adequate to insure that funds have
been expended in accordance with the terms of this Agreement.
4.6 GRANT DEL1VERABLES. The Grantee will submit the following Grant deliverables
in accordance with the Grant Agreement provisions referenced herein:
(I) Project Status and Expenditure Reports (Section 2.5)
(ii) Financial Close-out Package (Section 5.4B); and
(Hi) Audit (if applicable) (Section 2.1 and Section 5.4C)
4.7 PROCUREMENT OF CONSTRUCTION AND PROFESSIONAL SERVICES

ACQUISITION OF EQUIPMENT OR LAND. The Grantee shall procure all construction
and professional services, and acquire land, equipment and materials financed in whole
or in part with grant funds provided hereunder, through written, contractual
agreement(s), which specify the rights and obligations of both parties relevant to the
specified transaction
4.8 DUE DILIGENCE IN EXPENDITURE OF FUNDS. Grantee shall ensure that grant
funds are expended in accordance with the following principles:
(i) Grant expenditures should be made in accordance with generally accepted sound
business practices, arms length bargaining, applicable federal and State laws and
regulations, and the terms and conditions of this Agreement;
(ii) Grant expenditures should not exceed the amount which would be incurred by a
prudent person under the circumstances prevailing at the time the decision is made to
incur the costs; and
(iii) Grant expenditures should be consistent with generally accepted accounting

principles.
4.9 LEGAL COMPLIANCE. In addition to complying with the statutes and regulations
specifically referenced in this Agreement, the Grantee is responsible for determining the
applicability of and complying with any other laws, regulations, ordinances, etc. which
govern the Grantee's performance of the activities described in Part III hereof, including,
but not limited purchasing/procurement rules, to the Prevailing Wage Act (820 ILCS
130/0.01 et seq.) and the Interagency Wetlands Policy Act (20 ILCS 830/1 et. seq.).
PART V
GENERAL PROVISIONS
5.1 GRANTEE AUTHORITY: INDEPENDENCE OF ftRANTEE PERSONNEL: GRANTOR

AUTHORITY: GOVERNING LAW.
A. Grantee Authority. The Grantee warrants that it is the real party in interest to this
Agreement, that it is not acting for or on behalf of an undisclosed party, and that it possesses
legal authority to apply for this grant and to execute the proposed program or project
described in Part III hereof. Grantee's execution of this Agreement shall serve as its
attestation that Grantee has read, understands and agrees to all provisions of this Agreement
and to be bound thereby. Grantee further acknowledges that the individual executing this
agreement is authorized to do so on Grantee's behalf.
B. Independence of Grantee Personnel. All technical, clerical, and other personnel

necessary for the performance required by this Agreement shall be employed, or contracted
with, by Grantee, and shall in all respects be subject to the rules and regulations of Grantee
governing its employees. Neither Grantee nor its personnel shall be considered to be the
agents or employees of the Department.
C. Grantor Authority. The Department and its payroll employees, when acting pursuant to
this Agreement, are acting as State officials in their official capacity and not personally or as
the agents of others.
D. Governing Law. This Grant is awarded in the State of Illinois for execution within the
State of Illinois. This Agreement shall be governed by and construed according to Illinois law
as that law would be interpreted by an Illinois Court. Where there is no Illinois law on a
particular subject or issue, then the applicable law will be applied as it would be if interpreted
and applied by an Illinois court.
5.2 SCOPE OF WORK. In consideration for the grant funds to be provided by the
Department, the Grantee agrees to perform the project described in Part III hereof and to
prepare and submit to the Department the reports and other deliverables described in this
Agreement.
5.3 FISCAL RESPONSIBILITIES.
A. Non Appropriation Clause. Payments pursuant to this Agreement are subject to the
availability of applicable Federal and State funding from the Department and their
appropriation and authorized expenditure under state law. Obligations of the State will cease
immediately without penalty or liability of further payment being required if in any fiscal year
that this Agreement is in effect the Illinois General Assembly or Federal funding source fails to
appropriate or otherwise make available sufficient funds for this grant. •
The Grantee hereby is given actual knowledge of the fact that pursuant to the State Finance
Act, 30 ILCS 105/30, payments under this grant are contingent upon there existing a valid
appropriation therefor and that no officer shall contract any indebtedness on behalf of the
State, or assume to bind the State in an amount in excess of the money appropriated, unless
expressly authorized by law. If this is a multi-year grant, it is void by operation.of law if the
Department fails to obtain the requisite appropriation to pay the grant in any year in which
this Agreement is in effect.
B. Total Amount of Grant Limited. The Grantee expressly understands and agrees that the
total financial obligation of the Department under this Agreement shall not exceed the total
grant amount set forth on the Notice of Grant Award and the Grantee agrees expressly to fully
complete the Scope of Work specified in this Agreement and all other obligations under this
Agreement within the stated total consideration.
C Delivery of Grantee Payments. Payment to the Grantee under this Agreement shall be
made payable in the name of the Grantee and sent to the person and place specified in the
Notice of Grant Award. The Grantee may change the person to whom payments are sent, or
the place to which payments are sent by written notice to the Department signed by the
Grantee. No such change or payment notice shall be binding upon the Department until ten
(10) business days after actual receipt.
5.4 RECORDS RETENTION AND ACCESS TO RECORDS: PROJECT CLOSEOUT:

ACCOUNTING: AND AUDIT REQUIREMENTS.
A. Records Retention. The Grantee is accountable for all funds received under this
Agreement and shall maintain, for a minimum of three (3) years following the later of the
expiration or termination of this Agreement, adequate books, records, and supporting
documents to verify the amount, recipients and uses of all disbursements of funds passing in
conjunction with this Agreement. This Agreement and all books, records and supporting
documents related hereto shall be available for inspection and audit by the Department, the
Auditor General of the State of Illinois, or any of their duly authorized representatives, and the
Grantee agrees to cooperate fully with any audit conducted by the Auditor General or the
Department. Grantee agrees to provide full access to all relevant materials and to provide
copies of same upon request. Failure to maintain books, records and supporting documents
required by this Section 5.4 shall establish a presumption in favor of the Department for the
recovery of any funds paid by the Department under this Agreement for which adequate
books, records and supporting documentation are not available to support their purported
disbursement.
If any of the services to be performed under this Agreement are subcontracted, the Grantee
shall include in all subcontracts covering such services, a provision that the Department and
the Auditor General of the State of Illinois, or any of their duly authorized representatives, will
have full access to and the right to examine any pertinent books, documents, papers'and
records of any such subcontractor involving transactions related to this Agreement for a
period of three (3) years from the later of the expiration or termination of this Agreement.
B- Grant Closeout. In addition to any other reporting requirements specified in this

Agreement, the Grantee shall complete and submit a final Grant Closeout Report on forms
provided by the Department, within time limits established by the Department, after the
expiration or termination of this Agreement. The Grantee must report on the expenditure of
grant funds provided by the State, and if applicable, the Grantee's required matching funds.
The Grantee is responsible for taking the necessary steps to correct any deficiencies disclosed
by such Grant Closeout Report, including such action as the Department, based on its review
of the Grant Closeout Report, may direct.
In accordance with the Illinois Grant Funds Recovery Act, 30 ILCS 705/1 et seq., the Grantee
must, within 45 days of the expiration or termination of this Agreement, refund to the
Department, any balance of funds which is unobligated at the end of the Grant term specified
in the Notice of Grant Award. For purposes of preparation of grant closeout forms, the
determination of allowable expenditures and excess grant funds shall be based on the premise
that the total Grantee compensation under this Agreement shall not exceed the amount
specified in the Notice of Grant Award.
C. Audit Requirements. If required by Part II of this Grant Agreement, the Grantee shall be
required to have an audit conducted in accordance with the following terms:
a. State Audit Requirements;
(i) The audit shall be conducted by a certified public accountant who is licensed by
the State of Illinois to conduct an audit in accordance with Generally Accepted
Auditing Standards.
(ii) Grant funds shall be included in the Grantee's annual audit, unless the
Department authorizes the Grantee to have a grant-specific audit conducted.
(iii) Upon completion of an audit, an audit report shall be issued and the Grantee
shall provide the Department with a copy of such audit report.
(iv) The Grantee shall provide the Department with a copy of an audit report within 30
days of the Grantee's receipt of such audit report, but in no event later than nine
months following the end of the period for which the audit was performed. The
Grantee shall send the audit report to the Department at the following address:

Division of Audits
620 East Adams
D. Worker's Compensation Insurance. Social Security. Retirement and Health Insurance

Benefits, and Taxes. The Grantee shall provide Worker's Compensation insurance where the
same is required and shall accept full responsibility for the payment of unemployment
insurance, premiums for Workers' Compensation, Social Security and retirement and health
insurance benefits, as well as all income tax deduction and any other taxes or payroll
deductions required by law for its employees who are performing services specified by this
Agreement.
5.5 TERMINATION: SUSPENSION.
A. This Agreement may be terminated as follows:

1. Due *° Loss of Funding. Obligations of the State will cease immediately without
penalty of further payment being required if in any fiscal year the Illinois General Assembly or
Federal funding source fails to appropriate or otherwise make available sufficient funds for this
Agreement. In the event the Department suffers such a loss of funding in full or in part the
Department shall give the Grantee written notice which shall set forth the effective date of' full
or partial termination, or if a change in funding is required, setting forth the change in funding
and the changes in the approved budget.
2. For Cause. If the Department determines that the Grantee has failed to comply with
any of the terms, conditions or provisions of this Agreement, or any other Agreement executed
by the Department and the Grantee, including any applicable rules or regulations the
Department may terminate this Agreement in whole or in part at any time before the
expiration date of this Agreement. The Department shall notify the Grantee in writing of the
reasons for the termination and the effective date of the termination. Grantee shall not incur
any costs after the effective date of the termination. Payments made to the Grantee or
recovery by the Department shall be in accord with the legal rights and liabilities of the
parties.
In the event of termination for .cause, Grantee shall also be subject to any other applicable
provisions specified elsewhere in this Agreement.
Termination for cause may render the Grantee ineligible for consideration for future grants
from the Department.
3. For Convenience. The Department or the Grantee may terminate this Agreement in
whole or in part when the Department and the Grantee agree that continuation of the program
objectives would not produce beneficial results commensurate with the further expenditure of
funds. The Department and the Grantee shall agree upon termination conditions including the
effective date and, in the case of partial termination, the portion to be terminated. The
Grantee shall not incur new obligations for the terminated portion after the effective date, and
shall cancel as many outstanding obligations as possible. The Department shall allow full
credit to the Grantee for the Department's share of the non-cancelled obligations, if properly
incurred by the Grantee prior to termination.
B. Suspension. If the Grantee fails to comply with the specific conditions and/or general
terms and conditions of this Agreement, the Department may, after written notice to the
Grantee, suspend this Agreement, withhold further payments and prohibit the Grantee from
incurring additional obligations of grant funds, pending corrective action by the Grantee or a
decision to terminate this Agreement. Department may determine to allow such necessary
and proper costs which the Grantee could not reasonably avoid during the period of
suspension provided that the Department agrees that such costs were necessary and
reasonable and incurred in accordance with the provisions of this Agreement.
Section 5.6 INDEMNIFICATION
A- Non-governmental entities. The Grantee agrees to indemnify and hold the Department
and/or the State of Illinois, and its officers, agents, or employees harmless from and against
any and all claims, and actions, including but not limited to, attorneys' fees, costs and
interest, based upon and arising out of any services performed under this Agreement by the
Grantee and its officers, employees, agents, independent contractors, subcontractors,
subrecipients, volunteers, or other associates. The Grantee shall further indemnify and hold
the Department and/or the State of Illinois and/or its officers, agents and employees
harmless from and against any and all liabilities, demands, claims, damages, suits costs, fees
and expenses incident thereto, for injuries or death to persons and for loss or damage to or
destruction of property because of negligence, intentional acts or omissions on the part of
Grantee, its officers, employees, agents, independent contractors," subcontractors,
subrecipients, volunteers or other associates, arising out of any services performed under this
Agreement.
The Grantee further agrees to indemnify, save and hold harmless the Department, its officers,
agents and employees against any liability, including costs and expenses associated with the
violation of general, proprietary rights, copyrights or rights of privacy of third parties arising
out of the publication, translation, reproduction, delivery, performance, use or disposition of
any data developed or furnished under this Agreement or any libelous or any unlawful matter
contained therein.
B. Governmental Entities. In the event that the Grantee is a Governmental Entity, it will
indemnify and hold harmless the Department as set out herein to the extent authorized by
Federal and/or State constitutions(s) and/or laws.
C. Notice. In the event that any demand or claim relating to the transactions or activities
pursuant to this Agreement is made known to either party, the Department and/or the
Grantee will notify the other party to this Agreement in writing in an expedient manner.
5.7 MODIFICATION BY OPERATION OF LAW: DISCRETIONARY MODIFICATIONS: BUDGET

MODIFICATION
A. Modifications bv Operation of Law. This Agreement is subject to such modifications as

the Department determines may be required by changes in Federal or State law or regulations
applicable to this Agreement. Any such required modification shall be incorporated into and
be part of this Agreement as if fully set forth herein. The Department shall timely notify the
Grantee of any pending implementation of or proposed amendment to such regulations of
which it has notice.
B. Budget Modifications. Budget modifications shall be made in accordance with any

applicable provisions as specified elsewhere in this Agreement.
C. Discretionary Modifications. If either the Department or the Grantee wishes to modify

the terms of this Agreement other than as set forth in Sections A and B above, written notice
of the proposed modification must be given to the other party. No modification will take effect
until it is agreed to in writing by both the Department and the Grantee, except that if the
Department notifies the Grantee in writing of a proposed modification without the prior written
approval of the Grantee, failure of the Grantee to object in writing, specifying the reasons for
the objections, within thirty (30) calendar days from the date of the Department's notice to the
Grantee of such proposed modification, the modification will be deemed to be approved by the
Grantee. The Department's notice to the Grantee shall contain the Grantee name, Grant
number, modification number, purpose of the revision and signature of the Department's
director.
5.8 CONFLICT OF INTEREST: INTEREST OF PUBLIC OFFICIALS/EMPLOYEES:

BONUS/COMMISSION PROHIBITED: HIRING OF STATE EMPLOYEES.PRQHIBITED.
A. Conflict of Interest. The Grantee shall establish safeguards to prohibit officers, directors,
agents, employees and family members from using positions of employment for a purpose
that is, or gives the appearance of, being motivated by a desire for a private gain for
themselves or others, particularly those with whom they have family business or other ties.
Safeguards, evidenced by rules or bylaws, shall be established to prohibit persons from
engaging in actions which create or which appear to create a conflict of interest as described
herein or in Section 2.6 of this Agreement.
B. Interest of Public Officials/Employees.
(■) Governmental Entity. If the Grantee is a governmental entity, the Grantee certifies
that no officer or employee of the Grantee and no member of its governing body and no other
public official of the locality in which the program objectives will be carried out who exercises
any functions or responsibilities in the review or approval of the undertaking or carrying out of
such objectives shall participate in any decision relating to any contract negotiated under a
program grant which affects his/her personal interest or the interest of any corporation,
partnership or association in which he/she is directly or indirectly interested, or has any
financial interest, direct or indirect, in such contract or in the work to be performed under
such contract.
00 Nongovernmental Entity. If the Grantee is a nongovernmental entity, it shall comply

with the provisions of Section 2.6 hereof relative to conflict of interest.
Violations of this Section 5.8 (and 2.6 for non-governmental entities) may result in suspension
or termination of this Agreement, and recovery of grant funds provided hereunder. Violators
may also be criminally liable under other applicable State laws and subject to actions up to
and including felony prosecution.
C Bonus or Commission Prohibited. The Grantee shall not pay any bonus or commission
for the purpose of obtaining the grant awarded under this Agreement.
D. Hiring State Employees Prohibited. No State officer or employee may be hired to

perform services under this Agreement, or be paid with funds derived directly or indirectly
through this grant without the written approval of the Department.
5.9 APPLICABLE STATUTES.
A- Grantee Responsibility. All applicable Federal, State and local laws, rules and
regulations governing the performance required by Grantee shall apply to this Agreement and
will be deemed to be included in this Agreement the same as though written herein in full.
Grantee is responsible for ensuring compliance with all applicable laws, rules and regulations,
including, but not limited to those specifically referenced herein. Except where expressly
required by applicable laws and regulations, the Department shall not be responsible for
monitoring Grantee's compliance.
B. Land Trust/Beneficial Disclosure Act ( 765 ILCS 405/2.1V No grant award funds shall
be paid to any trustee of a land trust, or any beneficiary or beneficiaries of a land trust, for any
purpose relating to the land which is the subject of such trust, any interest in such land,
improvements to such land or use of such land unless an affidavit is first filed with the
Department identifying each beneficiary of the land trust by name and address and defining
such interest therein.
C. Historic Preservation Act (20 ILCS 3420/1 et seq.1 The Grantee will not expend funds
under this Agreement which result in the destruction, alteration, renovation, transfer or sale,
or utilization of a historic property, structure or structures, or in the introduction of visual,
audible or atmospheric elements to a historic property, structure or structures, which will
result in the change in the character or use of any historic property.
D. State of Illinois Discrimination Laws (775 ILCS 5/1-101. et. seq.V In carrying out the
performance required under this Agreement, the Grantee shall comply with all applicable
provisions of the Illinois Human Rights Act, and rules and regulations promulgated by the
Illinois Department of Human Rights, prohibiting unlawful discrimination in employment.
Grantee's failure to comply with all applicable provisions of the Illinois Human Rights Act, or
applicable rules and regulations promulgated thereunder, may result in a determination that
Grantee is ineligible for future contracts or subcontracts with the State of Illinois or any of its
political subdivisions or municipal corporations, and this Agreement may be canceled or
voided in whole or in part, and such other sanctions or penalties may be imposed or remedies
invoked as provided by statute or regulation.
E. Drugfree Workplace Act (30 ILCS 580/1. et. seq.V Grantee will make the certification
required in this Agreement and will comply with all of the provisions of the Drugfree Workplace
Act that are applicable to the Grantee. False certification or violation of the requirements of
the Drugfree Workplace Act may result in sanctions including, but not limited to, suspension
of grant payments, termination of this Agreement and debarment of contracting or grant
opportunities with the State for at least one (1) year but not more than five (5) years.
F- Freedom of Information Act (5 ILCS 140/1 et. seq.t. Applications, programmatic reports
and other information obtained by the Department under this Agreement shall be
administered pursuant to the Freedom of Information Act. The Department shall give Grantee
timely notice in the event it receives a request for information submitted by Grantee relative
to this Agreement.
5.10 MISCELLANEOUS PROVISIONS.
A. Waivers. A waiver of any condition of this Agreement must be requested in writing. No

waiver of any condition of this Agreement may be effective unless in writing from the Director
of the Department.
B. Assignment. The benefits of this Agreement and the rights, duties and responsibilities of
the Grantee under this Agreement may not be assigned (in whole or in part) except with the
express written approval of the Department acting through its Director. Any assignment by
the Grantee in violation of this provision renders this Agreement voidable by the Department.
C. Severabilitv Clause. If any provision under this Agreement or its application to any
person or circumstances is held invalid by any court of competent jurisdiction, this invalidity
does not affect any other provision or its application of this Agreement which can be given
effect without the invalid provision or application.
D. Integration Clause. This Agreement, with attachments, as written, is the full and
complete agreement between the parties and there are no oral agreements or understandings
between the parties other than what has been reduced to writing herein.
E. Comptroller Filing Notice. The Grantee expressly understands that whenever applicable,
a copy of this Agreement and any modification, cancellation or renewal is required to-be filed
by the Department with the State Comptroller.
F. Subcontract and Grants. The Grantee's services, duties and responsibilities specified
herein shall not be subcontracted or subgranted by the Grantee without prior written approval
of the Department, unless such subcontracts or subgrants are provided for elsewhere in this
Agreement. Any subcontracts or subgrants shall be subject to, and conform with, all
applicable State and Federal laws, and shall specifically provide that subcontractors or
subgrantees are subject to all of the terms and conditions of this Agreement.
30OJ
Nov-14-2000 16:09 Froi-DCCA IL FIRST 217-557-9883 T-817 P 026/065 F-732
PART VI
CERTIFICATIONS
The Grantee makes the following certifications as a condition of this Agreement. These
certifications are required by State statute and are in addition to any certifications required
by any Federal funding source as set forth in this Agreement. Grantee's execution of this
Agreement shall serve as its attestation that the certifications made herein are true and
correct.
6.1 COMPLIANCE WITH APPLICABLE LAW. The Grantee certifies that it shall comply with all
applicable provisions of Federal, State and local law in the performance of its obligations
pursuant to this Agreement.
6.2 CONFLICT OF INTEREST. The Grantee certifies that it has no public or private interest,
direct or indirect, and shall not acquire directly or indirectly any such interest which does or
may conflict in any manner with the performance of Grantee's services and obligations under
this Agreement.
6.3 BID.RIGGING/B1D-ROTATING. The Grantee certifies that it has not been barred from
contracting with a unit of State or local government as a result of a violation of Section 33E-3
or 33E-4 of the Criminal Code of 1961 (720 ILCS 5/33 E-3 and 5/33 E!-4).
6.4 DEFAULT ON EDUCATIONAL LOAN. The Grantee certifies that this Agreement is not in
violation of the Educational Loan Default Act (5 ILCS 385/3) prohibiting certain contracts to
individuals who are in default on an educational loan.
6.5 AMERICANS WITH DISABILITIES ACT. The Americans with Disabilities Act (ADA) (42
U.S.C. 12101 et. seq.) and the regulations thereunder (28 CFR 35.130) prohibit
discrimination against persons with disabilities by the State, whether directly or through
receiving this grant, the Grantee certifies that services, programs and activities provided
under this Agreement are, and will continue to be, in compliance with the ADA.
6.6 DRUGFREE WORKPLACE ACT. The Grantee certifies that:
A) A It is a Corporation, Partnership, or other entity (other than an individual) with 24

C) . It is a Corporation, Partnership, or other entity (other than an individual) with 25

If Option "A" or "B" is checked this Agreement is not subject to the requirements of the Act.
l«Snnnm" " "°\uS F"*"* a"d the am°Unt °f this Srant is five thousand dollars
($5,000.00) or more, the Grantee is notified that the Drugfree Workplace Act (30 ILCS 580/1
et seq.) is applicable to this Agreement, and the Grantee must comply with the terms of said
Act, as set forth below:
Grantee will provide a drugfree workplace by:
(a) Publishing a statement:
(i) Notifying employees that the unlawful manufacture, distribution, dispensing

possession or use of a controlled substance, including cannabis, is prohibited in the
Grantee's workplace.
(ii) Specifying the actions that will be taken against employees for violations of such
prohibition.
(iii)Notifying the employee that, as a condition of employment on such grant the

employee will:
(A) abide by the terms of the statement; and
(B) notify the employer of any criminal drug statute conviction for a violation
occurring in the workplace no later than five (5) days after such conviction.
(b) Establishing a drug free awareness program to inform employees about:
(i) the dangers of drug abuse in the workplace;
(ii) the Grantee's policy of maintaining a drug free workplace;
(iii)any available drug counseling, rehabilitation and employee assistance programs; and
(iv)the penalties that may be imposed upon an employee for drug violations.
(c) Providing a copy of the statement required by subparagraph (a) to each employee
engaged in the performance of the grant and to post the statement in a prominent place
in the workplace.
(d) Notifying the granting agency within ten (10) days after receiving notice, under part (B) of
paragraph (iii) of subsection (a) above, from an employee or otherwise receiving actual
notice of such conviction.
(e) Imposing a sanction on, or requiring the satisfactory participation in, a drug abuse
assistance or rehabilitation program by any employee who is so convicted, as required by
Section 5 of the Drugfree Workplace Act, 30 ILCS 580/5.
(f) Assisting employees in selecting a course of action in the event drug counseling
treatment and rehabilitation are required and indicating that a trained referral team is in
place.
(g) Making a good faith effort to continue to maintain a drugfree workplace through
implementation of the Drugfree Workplace Act, 30 ILCS 580/5.
If Grantee is an individual, it certifies that it will not engage in the unlawful manufacture
distribution, dispensation, possession, or use of a controlled substance in the performance of
this Agreement.
6.7 ANTI-BRIBERY. The Grantee certifies that neither it nor its employees have been
convicted of bribing or attempting to bribe an officer or employee of the State of Illinois, nor
has Grantee or any of its employees made an admission of guilt of such conduct which' is a
matter of record as defined in the Illinois Procurement Code (30 ILCS 500/50-5).
6-3 DISCRIMINATION/ILLINOIS HUMAN RIGHTS ACT The Grantee certifies (i) that it will
not commit unlawful discrimination in employment in Illinois as that term is defined in Article
2 of said Act; (ii) that it will comply with the provisions of Article 5 of the Act regarding equal
employment opportunities and affirmative action; and, (iii) that it will comply with policies and
procedures established by the Department of Human Rights under Article 7 of the Act
regarding equal employment opportunities and affirmative action.
The Grantee further certifies that, if applicable, it will comply with "An Act to prohibit
discrimination and intimidation on account of race, creed, color, sex, religion, physical or
mental handicap unrelated to ability or national origin in employment under contracts for
public buildings or public works." (775 ILCS 10/0.01 et. seq.)
6-9 SEXUAL HARASSMENT. The Grantee certifies that it has written sexual harassment
policies that shall include, at a minimum, the following information: (i) the illegality of sexual
harassment; (ii) the definition of sexual harassment under State law; (iii) a description of
sexual harassment, utilizing examples; (iv) the Grantee's internal complaint process including
penalties; (v) the legal recourse, investigative and complaint process available through the
Department of Human Rights and the Human Rights Commission; (vi) directions on how to
contact the Department and Commission; and (vii) protection against retaliation as provided
by Section 6-101 of the Illinois Human Rights Act (775 ILCS 5/2-105 (B)(5). A copy of the
policies shall be provided to the Department upon request.
6-10 INTERNATIONAL ANTI-BOYCOTT CERTIFICATION The Grantee hereby certifies that

neither the Grantee nor any substantially owned affiliate company of the Grantee is
participating or will participate in an international boycott, as defined by the provisions of the
U.S. Export Administration Act of 1979, or as defined by the regulations of the U.S.
Department of Commerce, promulgated pursuant to that Act (30 ILCS 582/1 et seq.).
George H. Ryan
Governor 'am McDono
Director
May 01, 2001
Ms. Carol Spizzirri

President/Founder
Dear Ms. Spizzirri:
Your executed grant agreement for Illinois FIRST grant 01-120390 requires that your
organization submit quarterly reports as a condition of receiving the grant Our records
indicate that the following quarterly report(s) for your grant has/have not been received-
Reporting Period Quarterly Status Report Quarterly Expense Report Yeai

01/01/2001 -03/31/2001
In order to ensure compliance with the grant agreement, please mail the quarterly
report(s) to my attention within 15 business days of the date of this letter Reporting
forms and instructions are attached for your use. If you have any questions reeardine
your grant, please call me at 217-782-5346.
Sin
>usan/6oggs
Grant! Manager
Illinois FIRST Unit
Attachments
cc: File
Internet Address http://w\w.commerce,state.il.us
•KffiCSS. mJ±ggsZ. ■CS.-SSSSSr
Primed on Rccvelcd and RcucUble Paper

GEORGE H. RYAN
DIRECTOR
June 22, 2002
Ms. Carol Spizzirri

Pres/Founder
Re: Grant No. 01-120390
Dear Ms. Spizzirri:
Enclosed is your fully executed copy of the modification to

your grant agreement between your agency and the Department of
Commerce and Community Affairs (DCCA). Please retain this
modification along with your grant agreement for future reference
If you have any questions regarding this modification,

please contact your DCCA Grant Manager.
Sincerely,
0
fMM
Pam McDonough
Director
Enclosure
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GRANT AGREEMENT MODIFICATION
1. Grant Recipient: JUN 11 2(

2. Grant Agreement: 01-120390 3. Modification No: 001
4. Current Grant Period: 07/01/2000 to 06/30/2002
5. Funding Source: COMM. ASSIST. - LEGISLATIVE
6. Purpose of Modification:
Change in Other Section in Accordance with Attachment

TO CHANGE THE FOLLOWING:
CHANGE IN OTHER SECTION IN ACCORDANCE WITH ATTACHMENT
BUDGET MODIFICATION
Except as modified herein, the basic Agreement remains unchanged,

including all prior modifications as agreed to by the parties.
7. This modification has the following effect on the total amount

of the Grant:
No Change
8. Signature:
Grantee:
Authorized Signature for Grantee
Name and Title
State ^>f Illinois Department of Commerce and Community Affairs
By: _ W
Pam McDonough, Director " Dat
06/10/2002 10:29:49
Transmittal Cover Sheet for
Illinois FIRST
Request for Modification/Waiver
GRANTEE NAME: Sai/jT A UP? fiftr/LÂil^ /A/r.
DCCA GRANT #: tJi
GRANT EXPIRATION DATE: P&> / 3b /
Grant Manager Certification

The Illinois FIRST grant manager or bureau coordinator responsible for this project hereby
certifies the following (check ALL that apply to the modification or waiver):
Q^The grant has not yet expired as of this submittal.

O The Grantee is requesting a change to the scope of work. I certify that the original scope of
work referenced in the attached Request for Modification/Waiver form is identical to the scope
oj,work that was included in the grant agreement or subsequent modification(s).
The Grantee is requesting a change to the budget. I certify that the original budget included
O"Thi
on the attached Request for Modification/Waiver form is identical to the budget that was
included in the grant agreement or subsequent modification(s).
□ The Grantee is requesting a date extension.
Q The Grantee is requesting a change other than those enumerated above, which requires Legal
review.
Q The Grantee is requesting a waiver from the audit provisions in the Grant Agreement.
(Division of Audits' Approval of this Waiver: _ j
Q This request was initiated by DCCA Accounting.
□ This request was initiated as a result of a DCCA Monitoring finding.
□ The proposed mod/waiver will affect a building, land or location other than that originally
submitted for environmental review.
□ The propo^Sd changes are within bond guidelines (this is applicable to bond-funded projects
Grant Manager or Bureau Coordinator signature Date/
DCCA Legal Action
Modification Approved • Grant manager is authorized to enter the modification into GRS and
transmit modification package to Accounting.
□ Modification Denied (see attached)
□ Approved as a Waiver • Grant manager is responsible to transmit a copy of this approved

waiver to the Grantee and to DCCA Accounting.
VHAAtAA
Legal signature Date
05/2B'2802 15:38 SflUE fl LIFE FOUNDATION * 12175579883 NO.632 D02
* ■ »

REQUEST FOR MODIFICATION/WAIVER'
GRANTEE NAME: .Sî/g /} Life. FatJtJhfrT'MfJ /a/C.

DCCA GRANT #: Ol-iA A* 46 (the "Agreement")
GRANT EXPIRATION DATE: 6L f 30 1
A. SCOPE OF WORK Please briefly detail why the modification to the scope of work is necessary. (A
copy of the original scope showing all proposed revisions must be attached to this request). Note: Revisions
will not be considered if they are inconsistent with the legislation authorizing the grant.
(0 B. BUDGET Using the form on the reverse, please list the original budget items and the requested revised
budget. Note: Requests for an increase in the total grant amount will be denied.
n r -DATE EXTENSION. jGraniee requires additional time to complete the-performance dcscwbed-io-Part III-
of the agreement for which grant funds are provided, and requests that it be allowed until . 200 , to
complete such performance. Grantee acknowledges that it has expended/legally obligated gram funds in the
performance required by the grant during the original grant term and that if granted, the extension of time cannot
exceed two (2) years.
D. OTHER Please anach a separate page identifying the provision(s) that grantee wishes to modify and a
written explanation supporting the request for change.
i //a/a a Po^t /
Signature for Grantee . Primed Name Date
DEPARTMENT ACTION;
Approved as a Modification, subject to the following conditions. OR
D Approved as a Waiver, subject to the following conditions:
(1) All terms and conditions of the grant agreement remain in full force and effect until all performance
required by the terms of die agreement are completed.
(2) If the period for performance has been extended, the close-out package referenced In Section 5.4B of the
Agreement must be submitted no later than 45 days following any extended performance date.
(3) This request is limited to the provisions described herein and in no way impairs the Department's ability to
seek legal recourse against the Grantee for non-compliance with either the provisions stated herein or any other
provisions of die Agreement.
D Denied (see attached)
PamMcDanough,Director V \hôp^ [) ' •""
NOTE: Due to the Time Limit on Expenditure or Grant Funds imposed by the Grant Funds Recovery Act
(30 1LCS 705/1 et seq.), the extended grant term granted herein shall be deemed to take effect on
cc: ^)U4AiJ D0te4 (Grant Manager); Kehh Burfclow (Accounting)
* Waivers will only be approved when the Department determines that it is in the best Interest of the State of Illinois.
05/29/2002 15:38 SflUE A LIFE FOUNDATION •> 12175579883 NO.632 003

EXPENSE REPORT
Grantee Name:
Dept. ol Commerce and Community Affairs
Grantee Address:
620 East Adams, Springfield, IL 62701
Grant No:
Prepared By:
Phone:
Final? (Y/N)
1
Budget_Li_neJte_ms or Approved Budget Prior Period Expenses Paid this Year-to-Date Funds Previously
AîiwitSes CQna^*ee rnusl (As in PART I of Year to-Date Report Period Expenditures Received
copy front Grant Grant Agreement Of Expenditures (Grnnt Funds Only) (2+3) (Grant Funds Only)
Agreernent_PART I pr subsequent <Grant Funds Only) (Grant Funds Only)
subsequenjrtiotljfjcation) modification)
-TO
315
Ctftk 51$ i :\
1M1O_
750
.-A16L
30 /5D0
TOTAL
EXPENSE REPORT
Grantee Name:
Grantee Address:
620 East Adams. SprinRfield. IL 62701
Report Period
Grant No: From: To:
Prepared By:
Phone: 1/00 Final? (Y/N) | A/0
1
BudgetLineJtems or Approved Budget Prior Period Expenses Paid this Year-to-Date Funds Previously
ActivMies (Granteernust (As in PART I of YeartoDate Report Period Expenditures Received
copy from Grant Grant Agreement or Expenditures (Grant Funds Only) (2+3) (Grant Funds Only)
Agreement PART I or subsequent (Grant Funds Only) (Grant Funds Only)
subsequent modification) modification)
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7
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TOTAL Mas, ooo
Grantee Certification Dcca Certification

Authorized Payment:
this agency.
Grant Perio##-/- 00 - >nd
Project Manager:
(date)
Signature t nd Title (date) AccountinRy (date)

STATUS REPORT
Report Period
5^ Jul 1 • Sep 30 due Oct 29

O Oct 1 • Dec 31 due Jan 31
D Jan 1 -Mar 31 due Apr 28
D Apr 1 -Jun 30 due Jul 31
Number of Persons Directly Benefiting or Served by the Project: D Final Report due 30 days attar
Proitct ComplMtd

Describe Significant Activities Undertaken with Grant Funds during the Quartiir

(RepprU are due no later than 30 days after completion ef all grant fundod project activities)
FINAL EXPENDITURE CERTIFICATION fAeeount of Expenditure hi Funds!

Amount of Federal Match Funds Expended on the Project $ o
Amount of Local Match Funds Expended on the Project: $ O
Amount of State Funds Expended (not including this grant) on the Project: $ Q
I hereby cenrfy that the information and data in this Program Status Report are true ;»nd correct to the best of the
Grtfnjee's (and the authorized representative's) knowledge and belief.
Title \h,
Name of Authorized santatiYe (Print/Typo)
Date
Signature of Authorized Representative
/
v£k/$72^
EXPENSE REPORT
Grantee Name: SAVS A Uf/T

Grantee Address: 4Q50 Si///r 30V 620 East Adams. Springfield, IL 62701
Report Period
Grant No:
Prepared By:
Phone:
Final? (Y/N) |
BudgeLLineJtems or Approved Budget Prior Period Expenses Paid this YeartoDate Funds Previously
Actjyitjes.(Grantee.must (As in PART I of YeartoDate Report Period Expenditures Received
copy from Grant Grant Agreement or Expenditures (Grant Funds Only) (2+3) (Grant Funds Only)
Agreement PART I or subsequent (Grant Funds Only) (Grant Funds Only)
subsequent modification! modification)
JUl 0
135
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SIS
¥50 150 /cso
ZW. 150 751) 150
A51L 1 0 {,50
MTf
30
Ml. 589 /soo
TOTAL
0 J2JL
Dcca Certification
Authorized Payment: $
file in our office, and that I have full signature authority to sign on behalf of "
this agency. Grant Period: FIF/Bond
Project
(date)
BY:
(date)
Authorized Official • Sifinature and Title (date) Accounting: (date)
EXPENSE REPORT
Grantee Name:
Grantee Address:
620 East Adams, Springfield. IL 62701
Report Period
Grant No:
From: To:
Prepared By:
Phone:
Final? (Y/N) |
BudgeLUneJtems or Approved Budget Prior Period Expenses Paid this YeartoDate Funds Previously
{As in PART I of YeartoDate Report Period Expenditures Received
copy from Grant Grant Agreement or Expenditures (Grant Funds Only) (2+3)
Agreement PART l" or subsequent (Grant Funds Only)
(Grant Funds Only)
subsequent modification^ (Grant Funds Only)
modification)
2>iUA&12M£atiL£4u£n
Authorized Payment: $
this agency. Grant Period: Ifap ~
02/22/2001 11:48 SflUE A LIFE FOUNDATION ■> 12175579883 NO.670 006

STATUS REPORT
Grantee Mama- A itfp
-T2J
Report PwpawiriI By;
Telephone: /a/? JTg.
Number of Persons Directly Benefiting or Served by the Project:,
Ret
Describe Significant Activities Undertaken with Grant Funds during the Quartur
nf inxirurttyS.
*" Final gwaluatlon Report

(Reports are due no later than 30 days after completion el all grant fundiid project activities)
nIA-
F1MAL EXPENDITURE CEBTlPICATIOM /Account of Expenditure cf

Amount of Federal Match Funds Expended on the Project O
Q
Amount of Loeal Malcn Funds Expended on tne Project:
Amount oi State Funds Expended (not including this grant) on the Project:
hereby canHy that the information and data in tnls Program Status Report are true nnd correct to the best of the
tee's (and tne authorized representative's) knowledge and Belief.
Title
a of/Authorized Representative (Print/Typa)
Signature of AUtnorizddf epresentative

Save A Lire Foundation, Inc.
Attachment fo lltfnois First Program Expense Report
01-120390
4 5
Prior Period Expenses Paid Year-to- Funds
Year-to-Date this Report Date Previously
Budget Line Items Approved Budget Expenditures Period Expenditures Received
Traintng Equipment (43 Mannequins) 4300 0 0 0 0

Director Salary 335 0 335 335 0
Accounting Clerk Salary 575 0 575 575 0
Project & RD Salary 1050 0 450 450 0
Service Coordinator Salary 750 0 750 750 0
MIS Salary 540 0 540 540 0
Scheduler Salary 650 0 0 0 0
Unemployment Ins 1287 0 176 176 0
30 Manuals 1500 0 589 589 0
412 Student Books S24 0 0 0 0
400 Completion cards 40 0 0 0 0
400 Certificates 260 0 0 0 0
30 Instructor Completion Cards 30 0 0 0 0
30 Instructor Certificates 30 0 0 0 0
30 Instructor ID's 150 0 0 0 0
30 Instructor Shirts 600 0 0 0 0
430 Pins 860 0 0 0 0
SALF Instructor & Senior
Police Instructor Fees 8266 0 0 0 0
Emergency Kits 2000 0 0 0 0
Rent & Insurance 913 Q 0 C a
Total (carried to previous page) 25000 fi

grantee Narne.
Grantee Address:
Grant No:
By;
Phone:
Expenditures Report Period VeartoDate

(Grant Funds Only) (Grant Funds Only) Expenditures
Received
(Grant Funds Only)
?!5l!nCATlON
=T^tt
rf-2000 09:16 Frm-DCCA IL FIRST 217-557-9863 T-420 P. 005/006 F-124

STATUS REPORT
Report Ptrtod
Grantee Name: =—=^>. gmrvtt +«T) f inc
Grant Number.£L=i2Q23Q O Jul 1 - Sep 30 due Oct 29
Address: Q Oct 1 • Dec 31 due Jan 31
Jan 1 • Mar 31 Q]_ due Apr 28
Report Prepared^ Apr 1 -*Jun 30 due Jul 31
Telephone: ^'j' —■ Final Report due 30 days after
Number of Persons Directly Benefiting or Served by the Project: Project Completed

Describe Significant Activities Undertaken with Grant Funds during the Quartur:
-/>. Conk" t r> Qn!

•} To X
j- ^fttUhlrt ^KillK , t-

'- (Reports are due no later than 30 days after completion of all grant funded project activities)
pi EXPEHDITURE cgftTIf ICATION f Armiwt of Expenditure of

Amount of Federal Match Funds Expended on the Project:
Amount of Local Match Funds Expended on the Project:
Amount oi State Funds Expended (not including this grant) on the Project:
. hereby certify that the information and data in this Program Status Report are true and^correct to the best of the
Grantee's (and the authorized representative's) knowledge and belief, r^ A
T '-fa* îijJkl Title ijt

Name ot Authorised peprosantative (Print(typa)
ive (Pri
Date
Signature of A^thoriad (Fêpresen Ttative
7
EXPENSE REPORT
Grantee Name: S/)i/£ A Utm /ZUMAAr/ort /a/a Depl. of Commerce and Community Affairs
FEIN:
Prepared By: From: To:
Date; Report #
Phone: Final?
Grantee Certification DCCA CERTIflCATJON

All expenditures from these project funds are tor approved project
costs only. Further, I certify that supporting documentation on actual Authorized Payment: $
expenditures is on file in our office, and that I have full signature
BY:
/ or Bureau Coordinator
(date! Accounting (date)
EXPENSE REPORT
Grantee Name: A Dept. of Commerce and Community Affairs

FEIN:
Grant Agreement No: 0/-/ Report Period
Prepared By: J~. Sfl/-T From: To:
Date: Report #
Phone: '-/-£>/ Final?
Grantee Certification DCCA CEftTIFICATION

All expenditures from these project funds are tor approved project
costs only. Further, I certify that supporting documentation on actual Authorized Payment? $
expenditures is on file in our office, and that I have full signature
sign on behalf of this agency. Project
Manager of Grant Unit f
or Bureau Coordinator U
nature and 1 tie (date) Accounting
331 3OOO
Nov-U-2000 16:11 Frco-OCCA IL FIRST

217-557-9883 T-917 V. 032/065 F-732

STATUS REPORT
Grantee Name: Sos/£ A Report Period

Grant Number 0/ -
Address: 4f>c ///. /mjoe/ur D Jul 1 • Sep 30 due Oc: 29
0AM /I D Oct 1 ■ Dec 31 due Jan 31
Report Prepared Bv: .0, ian 1 • Mar 31 due Apr 28
Telephone: &H1 H, Apr 1 • Jun 30 due Jul 31
Number of Persons Directly Benefiting or Served by the Project: Mao D Final Report due 30 days after
Project Completed
J.lZ'J &1//IM&IJ /Aj

FINAL EXPENDITURE CERTIFICATION rA^n.mt nf E,Dendit..n>

Amount of Federal Match Funds Expended on the Project: $.
Amount of Local Match Funds Expended on the Project: $.
Amount of State Funds Expended (not including this grant) on the Project:
I hereby certify that the information and data in this Program Status Report are true anc. correct to the best of the
Grantee s (and the authorized representatives) knowledge and belief.
Title rVp£.L>At/>££
of Authorized Representative
Date 7'.1C'~C>/
£'/'/U3Y£
^tOBST PROGRAM
EXPENSE REPORT
Grantee Name:
Grantee Address:
. of Cornice ,Com(ni|nI,yAHa
FEIN* t><io East Adams
Grant Agreement No-
Prepared By-
Sprfoglield, IL 62701
Date; Report Period
Phone:
rrror Period
•-xpenses PaidI v
Year-to-Date
tag
* I i a n 4. /> s\
Nov-H-tUQO 1 a: 11 rros-OCCA IL FIRST
217-537-3883 P. 032/065 F-F3Z

STATUS REPORT
Grantee Name: Sa\,s A /,** Report Period

Grant Number; 0/—
MI. TS Jul 1 • Sep 30 dueOc: 29
JJL D Oct 1 • Dec 31 due Jan 31
Report
p Prepared
p Bv: <LAno/, J-. . D Jan 1. • Mar 31 due Apr 28
Telephone:
Telephon 4ft-
4ft 4 4a a-g/.x*
ag 0 fpr 1 • Jun 30 due Jul 31
Number of Persons Directly Benefiting or Served by the Project D Final Report due 30 days after
Project Completed
/A 00 /A/

F1NAI. aPgNDITURF, CEBTjnCATinM Armm f P H,h,^

Amount of Federal Match Funds Expended on the Project
Amount of Local Match Funds Expended on the Project:
Amount of State Funds Expended (not including this grant) on the Project:
!4enJS JV1 h 2?3t *1 ifrtorTation and to* in this Program Status Report are true ana correct to the best of the
Grantee s (and the autnonzed representative's) knowledge and belief.
(Mjfnje of Aotnorjzea Representative (Print/Type)
Date
Signature of Adttiorii sentative
iC-e. Iof3
EXPENSE REPORT

FEIN:
Prepared By: From: To:
Date; Report U
Phone: Final?
Grantee Certification Dcca Certification

All expenditures Irom these project funds are for approved project
costs only. Further. I certify thai supporting documentalion on actual Authorized Payment;
expendllures Is on file In our office, and lhat I have full signature
authorily lo sign on behalf of this agency. Project Manager (date)
BV:
or Bureau Coordinator (date)
Authorized Official • Signature and Title Accounting
Nov-U-2000 16:1! FrcsHiCCA IL FIRST
ZU-55MS83 T-*\7 P.032/065 ?-?3Z
IUJNOIS FIRST PROGRAM

STATUS REPORT
Grantee Name: S/li/£ A /.f* Report Pcrtofl !

Grant Number Of
Address: -J Jul 1 • Sep 30 due Oc: 29 i
^1 Oct 1 • Dec 31 due Jan 31 '
Report Prepared Bv: <LAn6/, \r. D - Jan-1 • Mar 31 due Apr 28
Telephone:
n \prl- Jun 30 due Jul 31
Number of Persons Directly Benefiting or Served by the Project D Final Reoort due 30 days after
Project Completed
Quarterly Sta«u? p.,^ _
(Reports are due no later
lt than
th 3 days after end
30 of each quarter)
||taf p
(Reports are due no later than 30 days after completion of ail grant funded project activities)
FINAL EXPENDITURE ftTOTlflf^jtQM (Lmi,,^ n{ e

Amount of Federal Match Funds Expended on the Project —
Amount of Local Match Funds Expended on the Project
Amount of State Funds Expended (not inciuaing this grant) on me Project:
?|f|RST PROGRAM
Grantee Name- EXPENSE HEPORT -
Grantee Address:
Grant Agreement No:

Prepared By;
Date-
Phone: Report Period
O
Report # F 9 1
Final? ''
A" expenditures Irom

Executive Board
May 31, 2002
Carol J. Spizzirri, President/Founder
Hon. Sam Amirante, Vice President
Daniel Caravello, Treasurer

Susan Boggs, Grant Specialist
Hon. Martin A. Sandoval, Secretary
Directors
Carlos M. Azcotia IL Dept of Commerce & Community Affairs
Stanley Zydlo, M.D. 620 E. Adams St.
Springfield IL 62701
Scott Betzelos, M.D.
Deloris M. Bumam
Michael Lavelle, Esq.

Re: Grant No. 01-120390
Robert Conroy
Wayne Roberts, FF/EMT-P

Grant No. 01-124154
Legal Counsel
Robert Motta, Esq.

Dear Susan,
Medical Director
Stanley Zydlo, M.D.
Medical Advisors Enclosed are the Amended Status and Expense Reports of the Save A Life
Peter Safar, M.D. Foundation for the reporting period Jan. 1, 2002 to March 31, 2002. The
Henry Heimlich, M.D. amended forms reflect the amount for Instructor Fees overstated in
Stanley Zydlo, M.D. comparison to the budgeted line item amount.
Nicholas Bircher, M.D.
Mark Mitchell, D.O. Pending approval of the modification request to allow the line item
Emest A. Pretto, Jr., M.D. "Unemployment Insurance" to include payroll taxes, our final report will
Paula Willoughby, D.O. reflect an expense for the balance of that line item.
Illinois State Chairman Please contact me with your comments or for further information that may
Mark Mitchell, DO.
be needed. Thank you again for your assistance.
State Development
Sincerely.
Hon. Irv Bock
Ralph DeBartolo
National Advisory Board kfe

Hon. Rita Mullins
Linda Post
Garry B. Criddle Capt USC (Ret.)
Finance Director
Ellen Schmidt
Bill Nolan
Enc. 6 pages
Chris Hanna
Jeffrey A. Schwartz, MD FACEP
Stephanie Bryn, MPH
Marilyn J. Bull M.D.

Judy Robinson, PHD RN
Deborah Ann Mulligan-Smith M.D.

9950 West Lawrence Avenue, Suite #300, Schiller Park, Illinois 60176
Mary Jean Erschen R.N., B.S.N.
Phone: (847) 928-9683 (888) 892-0606 • Fax (847) 928-9684 • e-mail: salfkids@salf.org •www.salf.org
Confirmation Report - Memory Send
Tine : May-21-2002 01:46pn

Tel line : 217-557-9883
Naae : OCCA IL FIRST
Illinois
Department of Commerce and Community J\.ffairs
TELEFAX COVER SHBlBT

DATIi:
TO: bt
TELEFAX NUMBER: -•'.3.
From: Suton Bases. Grant Managsr

F«»x numbar: 217-867-0883
pnons numb»rai778aB3
b
E-mail addross; abagasi8oommareo.ataw.ll.ua
NUMBER OF PAGES TO FOLLOW!
st-/£i&4<r3*A&/y 4&m**s±+ze. 7a**T-s &rrss
,;,»„,« AMW. ■■BflW^.^.^Mg;.,^
r*» tif/nMliiarBa am
urn Illinois Department of Commerce and Community Affairs
George H. Rvan ' ~
Governor Pam McDonough
Director '
April 12.2002
Ms. Carol Spizzirri

President/Fou nder
Schiller Park. IL 60176-1216
Dear Ms. Spizzirri:
'• Please be aware that your Illinois FIRST grant number 01 -120390 is due to expire on June 30. 2002. The
Illinois Department of Commerce and Community Affairs, which administers your grant, would like to alert
you to your remaining responsibilities regarding this grant.
• If you will be unable to complete your project before June 30. 2002. the Department will consider a
request for an end date extension. The form you will need to modify your Grant Agreement is
attached. If an extension is necessary, please submit it immediately.
• If you have spent grant funds differently than your grant agreement authorized, you will need to use the
attached modification form to request a formal grant modification before your project can be closed.
(Your grant agreement allows a 10 percent variance in any budget line item without a modification. If
you have added any new line items or activities, eliminated any line items or activities, or exceeded the
10 percent variance in any line, you must file a request for a modification.) Please note that
modifications will not be granted if the expenditures are inconsistent with the authorizing legislation and
legislative intent. Once again, if a modification is necessary, please submit it immediately.
• Some Illinois FIRST projects are required to submit Quarterly Expense Reports and/or Status Reports.
Please continue to submit your reports as instructed by your grant manager, until your grant ends. If
any reports are delinquent, you must submit them before your grant will be allowed to close.
• If you do not take action to extend your grant, you can expect to receive your Close-out Package in
June; you must complete the package and submit it to the department by August 14, 2002.
If you have any questions regarding the contents of this package, or if you feel you have received this letter
in error, please call your Illinois FIRST program manager. Susan Boggs. at 217-782-5346.
Sincerely.
Ron Pufundc, Manager

Enclosure
Interne! Address hup: www commerce stale il us
,„..
>,. .mo
("raited on Rnulrvl nvl Rnt.

Confirmation Report — Memory Send
Time : Apr-04-2002 10:34am

Tel line : 217-557-9883
Name : OCCA IL FIRST
Job number : 714
Date : Apr-04 10:32am
To : 918479289684
Document pages : 002
Start time : Apr-04 10:33ara
End time : Apr-04 10:34am
Pages sent : 002
Status : OK
Job number : 714 *** SEND SUCCESSFUL ***
Illinois
TELEFAX COVER SHEET
DATE: O4/O4/O2
TO: Ms. Carol J. Spizzlrri

TELEFAX NUMBER: 847-928-9684
From: Susan Boggs, Grant Manager

Fox number: 217-687-9883
Phone number:217>782-6346
E-mail address: sboggsigieommerce.statQ.il.us
NUMBER OF PAGES TO FOLLOW: O
GOIvllvieNT8
Orant «tOT-12osnp la dua to expire on Juna> SO. 2OO2. In ordor to facilitate tria. tlmoly handling of your
inrtiuiduni r»»«»ri» ynur
y «Mi«t.mai |0 nsMoft. If you
y ana
na going
gng to require ■ dote axlonalon or a
modification to tno opprovad Scops of Work or Budget,
Budget we muot t Initiate
Iitit th
tho proeano ImmodlaMly
IdlMl I
In
ordor for Legal to hova tlmo to review and approva your raquaat. Rlooso toko a momant, review your
project ond Indicate tne atatua. Pleaso fax thin pago back to mo. If nocooiary, I will contact you.
ALL funds will be spent by O6/3O/O2 In accordance with tna approved Sonpe afWerfc and Budget
in tho Orant Agroamont
ALL funds will be spent by OB/3O/O2. but a Modification to the Soap* and/nr Budget In nacosaary
___ Funds will NOT bo spant by OS/3O/O2 and a date oxianalon la nocesoary
If any pages nuod to t>e msant, ploass call tno aandor. Olhonwlaa, we will aaauma
tranamlttal has boon eomplately received. Thank you.
UO« Wm* MalM. •«(•* I ■•

GEORGE H. RYAN - P.M M_noMniI_u

DIRECTOR
dune 06, 2002
Ms. Carol Spizzirri, Pres/Founder

Dear Ms. Spizzirri:
The Illinois Department of Commerce and Community Affairs Is currently

in the process of closing out the above referenced grant. To facilitate
this process we are enclosing a close-out package and applicable
instructions. Please complete the information requested and return

Accounting Office
620 E. Adams Street - 2nd Floor
If your grant agreement, under Part II, Section 2.5. requires a final
expense and status report; the submittal of the enclosed close-out
package will serve to satisfy the reporting requirements once vour
package is approved by the Department. y
If your grant agreement, under Part II, Section 2.5, requires quarternv
status and/or expense reports, you may elect not to submit the reports
——I^h^k* perjotl of vour 9rant agreement provided vou have already
received the full amount of the grant funds as stated in vour grant
agreement. In other words, if you have not received all of your orant
funds you must submit an expense report to request the remaining funds
prior to the completion and submittal of the enclosed close-out package.
You must continue to meet the requirements of proper cash management for
the remaining term of your grant by limiting cash to an amount necessary
to meet Immediate cash needs. Excess cash should be returned to the
Department immediately. Upon final submission of your close-out anv
remaining unexpended cash should be refunded as defined in the enclosed
procedures.
Should you have questions about the close-out package or instructions

please contact Kara Patton at (217) 785-6439. -nsirucxions
Sincerely,
Christ 1 DeGroot
Assistant Manager
Accounting Office
CC: Patty Hughes -■

Close-out File
Mffr««l Aaertll Wtfl JJw
Cte.c*«a. llli««.t tGMI «■"«•. HIM*.* HfSt
\ TOO ICCI71S-IM1 'AX 3I»| U-t;]) 10010OMK-CU) «•« ,,,„.. i,« *'"*°
• •» ii.rni-jiii ioDiiiirn.nli
• U/W1-4M4
luiiimi'im too looniiow
AFFAIRS
GEORGE H. RYAN
GOVERNOR
PAM MCDONOUGH
DIRECTOR
August Oft, 2002
5«CJP?LSpiz*1rrl' p
9950 LAWRENCE AVE STE300
Re: subgrant No. 01-120390 Close-Out Package

Dear Ms. Spizzirri:
coôT^
provided in your close-out packa™ wfto J3** the 'formation
compliance with the close-oCt wSJ
*» «■»* with the

all records documenting tta Sa^ F *»»* vo" <«> retaVn
three years following expiration of the frL funds for a Period of
with any audit conducted by the tZJ$ZjE? ^' and (H> cooperate
during this three year period? DePart"*nt. the State Auditor General
remedies available to it? iSi3l2 ?"7?U?*any and a11 1e9a'

grant funds, if, as the result of fnv i'? ted to «*««overy of
currently in process, any compHancS * ° °r f ^îa 1 review
the expiration date of th submitted after
three-year records ^
*M. grant were
P-isions of
Thank you for your cooperation in this matter.

Sincerely,
Christi DeGroot
Assistant Manager
Accounting Office
CC: Patty Hughes

Close-Out File
MJ I.,, »«,„,
. in,,.,, ,„„
"in »„». s«,i.
'<XHWII.HU
ID0,,,„„.„„, >■«•»-««
ILLINOIS DEPARTMENT OF COMMERCE AND COMMUNITY AFFAIRS'" DCCA'C'°
OFFICE OF ACCOUNTING ^v> ,.
GRflNTFES SUBMTTTAL OF CLOSE-OUT DOCUMEMTg *" *" r,.
rant Period: 07/01/2000 thru 06/30/2002

f^Save A Life Foundation
Required Identification of Document Enroled
1. Reconciliation Statement j.>< j

t 1
c~°~2 2. Final Expenditure Summary
r1
c-0-3 3. Grantee's Release j X j
c"°~4 4. Refund Check Breakout 1 1
B. Grantee's Assignment of j •
c~°~5 Refunds. Rebates a Credits I X j
C-0-6 B. Status Report jj X

*X II
Grant Close-Out Certification Statement
To the best of my knowledge and belief, the Financial Statements

contained in this close out package accurately represent the financial
position of this grant. The Statements are presented In conformit^wH
Generally Accepted Accounting Principles and there are no transactions
that have not been properly recorded.
cloôu? SnleKlf

I ,
FORM DCCA-C-O-1
RECONCILIATION STATEMENT
CASH BALANCE
1. Beginning Cash on Hand _£_
2. Total Amount of Grant money received
3. Total Cash Available (line 1 +2)
4. Less: Total Costs (Per Expenditure Summary Total _£JL400*

Form DCCA-C-0-2) J
5. Balance of Cash On Hand (line 3-4) -£?-
GRANT BALANCE
6. Total Grant Amount (Including all
modifications)
7. Total Grant Amount Received from D.C.C.A.
8. Unexpended Amount of Grant (line 6 - 7) -0-
Report of Grant Principal "

9. Grant Principal
a. Total Grant Amount
(Including all Modifications) a) + e?£'00$. 0/0
b. Total Interest Earned b) + -p—
c. Total Grant Amount plus Interest (a + b) = (C)
Less: Costs Incurred under Grant

d. Total Grant Amount Expended d) + £^000. 0/)
e. Total Interest Expended e)

(If grant agreement allows)
f. Total Costs Incurred (d + e) a (f) Jt&.000. 00
Equals: Unexpended Funds to be Returned to D.C.C.A.
g. Balance of Grant Amount g) + "&"

h. Balance of Interest Earned h) + -0 ~
i. Total Unexpended Grant Amount

and Interest (g + h) * (1)

DEPARTMENT OF COMMERCE AND COMMUNITY AFFAIR^™ DCCA'C"0"2
STANDARD EXPENDITURE SUMMARY
GRANTEE NAME: Save A Life Foundation
GRANT NO.: 01-120390 REPORT PERIOD: FROM 07/01/2000 THRU 06/30/2002
PHONE:
by.- A b ,*.*«■*«
Grantee Release

Pursuant to the terms of Grant No. 01-120390 and In

consideration of the sum of ltf.0/D0, 0?)
(Expend 1 turie Summary Total -FORM DCCA-C-0-2)
which has been or Is to be paid under the grant to:

hereinafter called the Grantee or to It's assignees if any the

Grantee, upon payment of the said sum the Department of Commerce and
Community Affairs hereinafter called the Grantor, does remiss, release
and discharge to Grantor. Its officers, agents and employees of and from
all liabilities, obligations, claims and demands whatsoever under or
arising from the said grant, except:
1. Specified claims in stated amounts or in estimated amounts

where the amounts are not susceptible of exact statement bv the
Grantee as follows: NONE »»
2. Claims, together with allowable expenses not to exceed qrant

balance, based upon the liabilities of the Grantee to third parties
arising out of the performance of the said grant, which are not
known to the Grantee on the date of execution of this release and of
which the Grantee gives notice in writing to the Grantor within the
period immediately following acknowledgement of said expenses.
It is the sole responsibility of the Grantee to timely notify the

Department of Commerce and Community Affairs if it Is aware of anv
Claims fitting this description. y

ILLINOIS DEPARTMENT OF COMMERCE AND COMMUNITY AFFaJSs" DCCA"C~°-4
REFUND CHECK BREAKOUT

DOLLAR AMHUMT
■1. Balance of DCCA Grant Amount

(Must equal Line No. 9g from the
DCCA-C-0-1) $ -0~
2. Unexpended Interest or Interest

earned on funds received.
Must refer to your grant agreement $ -0-
to determine interest requirements.
(Must equal line 9h as stated In the
DCCA-C-0-1).
3. Total Amount of Refund Check due DCCA % -s>~

(Line 1 plus line 2. Must equal line
91 as stated in the Reconciiaition
Statement - Form DCCA-C-0-1)

FORM DCCA-C-O-5

GRANTEE'S ASSIGNMENT OF REFUNDS AND CREDITS

Pursuant to the terms of Grant Agreement No. 01-120390

and In consideration of the reimbursement of costs and payment of fee
as provided in the said Grant and any assignment thereunder '

482S N Scott St Ste 74A
hereinafter called the Grantee does hereby:
1. Assign, transfer, set over and release to the Department of

Commerce and Community Affairs all right, title and Interest to all
refunds and credits or other amounts (Including any ntlrlst
thereon) due or which may become due, and forward promptly to the
STJCE1 °! C°Tm7si and Community Affairs check? (nSdepaJabV?
to the Department of Commerce and Community Affairs) for anv
£51* ?? ^l160*?*;, The re»s°™ble costs of any sulh action to
effect collection shall constitute allowable costs when approved bv
the Grantor as stated 1n the said grant and may be applied to reduce
any amounts otherwise payable to the Department of Commerce and
Community Affairs under the terms hereof. commerce ana
2. Agree to cooperate fully with the Department of Commerce and

community Affairs as to any claims or suit In connection with such
refunds and credits or other amounts due: to execute any protlst
pleading, application, power of attorney or other pape?s in
connection therewith; and to permit the Department of V
and Community Affairs to represent It In ahy heading,
other proceeding arising out of such claim or suit

$50,000 From IL Dept of Commerce To SALF To Provide 1st Aid Training To Chicago Police (2000-01)

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$50,000 From IL Dept of Commerce To SALF To Provide 1st Aid Training To Chicago Police (2000-01)

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FOR IMMEDIATE RELEASE

Other Illinois FIRST grants announced by Ryan:

• $200,000 to Harwood Heights to construct a new Municipal Complex.

• $100,000 to Leaning Tower YMCA, Niles to construct a new senior center.

• $35,000 to Joseph Academy, Niles to renovate a warehouse into an educational facility.

• $25,000 to Stock School, Chicago to purchase computers.

• $25,000 to Edison School, Chicago to purchase computers.

• $25,000 to Dirksen School, Chicago to purchase computer equipment.

• $12,500 to Beard School, Chicago to purchase computers.

TO: Ms. Carol Spizzirri, President

FROM: Susan Boggs, Illinois First Grant Management Unit

DATE: June 29, 2000

RE: FY 2001 Grant Appropriation

Project No.: SD0183

Completed surveys may be mailed to: DCCA

Or fax the survey to: 217/557-9883

Internet Address http://www.commerce.staie.il.us

:i7/7s:-7soo 3I2.'814-7IT9 217/7SJ-28OO 618/997-4394

Primed on Recycled and Recyclable Paper

City: S <:*,->''*■ c <r~/c ,^ Sute:

Far f <-V 7 E-mail address: _

Title: Contact's Phone ( )_

Far( ) - E-mail address:

TYPE OF ORGANIZATION (CAedkonfy one):

D Individual D Governmental Entity

FEIN:' [-digitfederal employer identification number)

Owner of FEIN: ■ — - •" " <- ■-">:-• ~t--L ,-i

6) Estimated Number of Persons to be Served/Benefited from Project _uf____

9) Timetable for Completion: Start Date C^ I G/ / QQ Completion Date: <^6 \ J C \QX

Month 1: $ 3 7«PQ Month 13: S

Month 2: ■--'■ ~/C C Month 14:

Month 3: .-2- > ~^ Month 15:

Month 4: •" - Month 16:

Months: -• !/ '; c Month 17:

Month 6: -' '" '<-' Month 18:

Month 7: • '- c' Month 19:

Month 8: " '"-'•' Month 20:

Month 9: '- ■' ■ *- Month 21:

Month 11: Month 23:

Month 12: Month 24:

ACTIVITY LINE ITEM GRANT AMOUNT OTHER PROJECT FUNDS

$3900 Salaried positions:

Training Equipment for Trainers:

Supplies issued to each new student:

Number of people: 30 police instructors to serve as SALF trainers.

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Overhead: $3,985 (approx)

• Amount of Federal Matching Funds: $ Status: D Approved D Pending

• Amount of Local Matching Funds: $ Status: D Approved □ Pending

{Name of Other State Funding Agency: 5<g-g==~ <& ^s<Z <£&£&-4? ; J

This survey was completed by.

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$3900 Salaried positions:

To: DCCA Department of Commerce and

From: Save A Life Foundation

Subject: $120 error on both applications

Correction of $120 reflected on Certificates as follows.

I'll be in Springfield all day if you need me, I'll be right

To all to whom these Presents Shall Come, Greeting:

I, Jesse White, Secretary of State of the State of Illinois, do

In Testimony Whereof, i, hereto set

City: S <:,->''■ c <r~/c ,^ Sute: